182756 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 362613 Page 1 of 1
ONE CIVIC SQUARE LINDSAY ATKINSON
0 CHECK AMOUNT: $103.69
CARMEL, INDIANA 46032
CHECK NUMBER: 182756
CHECK DATE: 3/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4343000 REIMB 103.69 TRAVEL FEES EXPENSE
c
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENRRAL FORM NO. 101 (3986}
MILEAGE CLAIM 11
TO 111
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFMCE. BOARD. DEPARTMENT CA 1NSTITUTIONI I 00
C R t H 3y. CCO l 1-l oo oo QO `4 3 f o
FROM TO SPEEDOMETER l y�J ((J J �f
DATE I READING AUTO MI[L�EiA�GE
POINT ppINT START FINISH NATURE OF BUSINESS TRAVELED 4
PER MILE
0\ -9 1 7� d0
1� rt
5 1.2 p
CO
11 Ear Sia I 11 1
I
I
4
AUTO LICENSE NO. I 7 TOTALS fj 'l Qd 1/
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map-
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credils
-and that no part of the same has been paid. �J
Date o� lo 4<•(�LIFJ -G'ti
4
CaFMCI 0 Clay
'arks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt 1 Vendor listed on receipt �i Line Budget Description Amount Purpose of Expense
V r y 2 e ;k �n 40 n IO Lj 4 34 0 fYaVgQ� �S Y S °�l )c i1^ N 4
1 1 Z� U i c.e W7 loo-loo WN go 0] v" Gin
v n CV)
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
Employee Name (print)
Address
Check
payable to: City, St, Zip 6
Signatur Approved
Date: a� I f Date:
Business Services Division, Revised 7 -7 -08
FILE: Shared%AdministrativelForms %Staff FormslEmployee Exp Reimb Request
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
362613 Atkinson, Lindsay Terms
11407 Teal St., 1408
Fishter, IN 46038
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/26/10 Reimb. Mileage 1/20 1/23/10
76.00
2/4/10 Reimb. IPRA conference expenses 27
Total 103.69
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
362613 Atkinson, Lindsay Allowed 20
11407 Teal St., 1408
Fishter, IN 46038
In Sum of$
103.69
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members
Dept
1091 Reimb. 4343000 76.00 1 hereby certify that the attached invoice(s), or
1091 Reimb. 4343000 27.69 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
rl� 25 -Feb 2010
Signature
103.69 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund