HomeMy WebLinkAbout185144 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 360484 Page 1 of 1
ONE CIVIC SQUARE AMY BALDAUF
o CARMEL, INDIANA 46032 126 LARK DR CHECK AMOUNT: $557,52
APT D
CHECK NUMBER: 185144
CARMEL IN 46032
CHECK DATE: 5/11/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 67.48 GENERAL PROGRAM SUPPL
1081 4.343000 RETMB 490.04 TRAVEL FEES EXPENSE
Carmel e Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
4910 C c A rA
4cl tq\�
e-s
CV M
'4 f 26 10 I�e� Zz
All receipts should be attached in the same order as listed above. a Z
No sales tax will be reimbursed. TOTAL:
i Employee Name (print) °l _L -,11� S M A Y 0" 20 10
Check
Address Y 22
payable to: City, St, Zip �OL WI I d quo 2
Signature: f I Approved by: �1
Date: `Jf Date: U I
Business Services Division, Revised 7 -7 -08
FILE: Shared\Administrative \Forms \Staff Forms \Employee Exp Reimb Request
Carmel Clay
Parrs &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
1 Q�d Ex ress L 3y300
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: 1 9 I -I
Employee Name (print)
Address MAY 2010
Check
_payable to: City, St, Zip CR f M d I N L A U nZ
Signature: P)C( Approved by:
Date: I �V Date:
Business Services Division, Revised 7 -7 -48
FILE: Shared\AdministrativelForms \Staff Forms \Employee Exp Reimb Request
Carrel o Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
HOW�j q0io3l �ktyt(c�l SL�a� 4_ (SI'LA� C' "s 2P') e
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
Employee Name (print) A m s n
Check Address (2t; LQ! (fir D
_payable to: City, St, Zip a -ej /n(
Signature: 4 AA" Approved by: yz
Date: Date J
Business Services Division, Revised 7 -7 -08
FILE: SharedlAdministrative \FormslStaff Forms\Employee Exp Reimb Request
PRESCRIBED BY STATE BOARD OF ACCOUR-M GrNERAL FORW 110. ,01 119M
MILEAGE CLAIM"
y
(OOVERNWENTAL IMM ON ACCOUNT OF APPROPRIATION NO. FOR
(OF,WP, BOARD. DEPARTKOff OR nIST MILK
FROM TO READING +t AUTO l
DATE i r E"
r
FINISH REAING NATURE OF BUSINESS TRAVELED R M!
POINT POINT START PER MILE
5 `L
S 5
5
5�
AUTO LICENSE NO. TOTALS I�" Z 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 foTegoing account is just and correct, that the amount claimed is legally due, alter aliowing all just credits r
and that no part of the same has been paid. fm T& qpn
Date MAY 0 4 2010
D O BIl:.���� O
VL
FRESCp1RLD BY STATE BOARD Of ACCOUNTS MILEAGE CLAI GENERALfDAL NC, 101 (14957
TO
(GOVERNMENTAL UNITE
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFn= BOARD. 6FPARTbUNT OR 1NSrnW1ON(
DATE SPEEDOMETER
FROM TO READING AUTO H�1LEA�E i c
NATURE OF BUSINESS
POINT POINT START FINISH TRAVELER PER MILE
1( G s v
PA T yet _I
Y 2 r\A M OVX4 ,Z
2
0.r g.
Y
AUTO LICENSE NO. TOTALS I �J
I c�
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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits
and that no pad of the same has been paid,
Date
PRBSCRIBED BY STATr BOARD OF ACCOUNR GrNGRAL FORM Bc, 101 11996)
MILEAGE CLAIM
TO �dn
C
4GOVERN34ENrA4 UNrrt ON ACCOUNT OF APPROPRIATION NO. FOR
(CORM, BOARD. D[PARTIO R OB TNSTMMONI
DATE FROM TO SREDIINM AUTO �E.
NATURE OF BUSINESS
POINT POINT START FINISH A MR I
PER MILE
NP\DL 2 5. 1
r -6 5
5
Ma y
Y mwal 5-
KMY 1 6 S
10
o
N\O ff Mrs I 5
7 1
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Y 4'f
NNXY J?
AUTO LICENSE NO. TOTALS
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 atiowing all just credits
end that no part of the same has been paid.
Date
PRESCRIBED BY STATE BOARD Of ACCOUMS rWER FORM U0. 101 11986)
MILEAGE CLAIMM
TO l�M�
(GOVERNMENTAL UNm
ON ACCOUNT OF APPROPRIATION NO. FOR
LOfi7CE, BOARD, DEPABTMOM OB Imur TIrloN)
SPEEDOMETER
DATE FROM TO READING I O �E r a
NATURE OF BUSINESS
4 POINT POINT START FINISH TRAVELED PER MILE
5 Y
b
AUTO LICENSE NO. TOTALS,
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 1853, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowing all just credits
and that no part of the same has been paid,
Date
�o� Uv1
PRESCRIBED BY STATE BOARD OF ACCOUNTS GEW"AL FORM NO. 10) 0"n
MILEAGE CLAI
(GOYERNNENrAL UNITt
ON ACCOUNT OF APPROPRIATION NO. FOR
tOFFICE, BOARD, Dr1ARTMDff OR [NSIXTUTION]
FROM TO SPEEDOMETER AUTO AGE
DATE READING
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED t
PER MILE
n
non
e s
NA tnEn 5
IFC'o V7 1 WOW
S
5
brls>
b
2 Oil S 5-5
I
o
51 4
O
1D ri
Z F
8 S Ql�
AUTO LICENSE NO. TOTALS
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 aliowing all just credits
end that no part of the same has been paid.
Date 300 qVA
PMCRIBED BY STATL HOARD OF ACCOUNTS p GFNFRAL FORM IIO, 101 119863
MILEAGE CL
TO
(G0VERNMENTAL UNITI ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE. BOARD, DEPARTW32rr OR IMSnTU[IOM)
SPEEDOMETER AUTO AGE
DATE FROM TO READING t NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED P WU
CA
4 JS
Mr) rn
CLYA S
EI 5.5
S tv10YL t
n u
Ail
1 Y1 T t.,
,f s
NAAnna S 1t
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5.5
AUTO LICENSE NO. TOTALS
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 Candy that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits
eud that no part of the same has been paid.
Date
�f
00
LJ W
Jot �y
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1905)
MILEAGE CLAIM I
To
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO- FOR
(OF:ICE, BOARD, DEPAATW0WT OR INSTITUTION)
SPEEDOMETER
AUTO E
FROM TO
DATE I READING
Zv q NATURE OF BUSINESS MILES
s-LJ- POINT POINT STRR7 FINISH TAAVELED PER MILE
C
22 6L
o
l� orl
C 5
Mznon
O
o n o
o r'c)
o n
b
O In I
M onon
r
AUTO LICENSE NO. TOTALS
i 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 aliowing all just credits
end that no part of the same has been paid.
Date
LDOVI
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.
360484 Baldauf, Amy Terms
126 Lark Dr., Apt. D Date Due
Carmel, IN 46032 }w
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
4/30/10 Reimb Natl Afterschool Assoc. Conference 1 29.23
4/29/10 Reimb Club supplies from Hobby Lobby 67.48
4/30/10 Reimb Mileage 12/1/09 4/27/10 360.81
Total 557.52
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
1 20
Clerk- Treasurer
i
Voucher No. Warrant No.
360484 Baldauf, Amy Allowed 20
126 Lark Dr., Apt. D
Carmel, IN 46032
In Sum of
557.52
ON ACCOUNT OF APPROPRIATION FOR j
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -99 reimb. 4343000 129.23 1 hereby certify that the attached invoice(s), or
1081 -8 reimb. 4239039 67.48 bill(s) is (are) true and correct and that the
1081 -8 reimb. 4343000 360.81 materials or services itemized thereon for
which charge is made were ordered and
received except
rr l6
5 -May 2010
Signature
557.52 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund