HomeMy WebLinkAbout186472 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 359461 Page 1 of 1
ONE CIVIC SQUARE NIKEESHA PITTMAN CHECK AMOUNT: $190.24
x CARMEL, INDIANA 46032 2713 HIGHLAND PLACE
INDIANAPOLIS IN 46206 CHECK NUMBER: 186472
CHECK DATE: 619/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 163.89 GENERAL PROGRAM SUPPL
1081 4343000 26.35 TRAVEL FEES EXPENSE
Carmel Clay
P arks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
9-Sep-09 Kroger 1081 -11 4239039 Marty Supplies $18.06 Site celebration Supplies
22 -Jan -10 Dollar General 1081 -11 4239039 Coloring Books; Worksheets $4.00 General Supplies
20-May-10 Jo -Ann Fabric 1081 -11 4239039 Fabric $41.83 t✓ Club Supplies Fashion 101
21-May-10 Baskin Robbins 1081 -11 4239039 Ice Cream $100.00 Site Celebration Supplies
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL $163.89
Employee Name (print) Nikeesha Pittman
Address 2713 Highland Place
Check
payable to: City, St, Zip Ilindianapolis, IN 46208
Signature: Y Approved by:
V
Date: .5/22/2010 Date: T 0
Business Services Division, Revised 7 -7 -08
FILE: Shared\Administrative \Forms \Staff Forms%Employee Exp Reimb Request
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110. 101 n906)
MILEAGE CLAIM
TO
TRAVEL PEe DIEM 11 4
C.X� l.1UQ7 It 3i1�1��
C IG vERNMENIAL III ON ACCOUNT OF APPROPRIATION NO. FOA �M
(OFiICE, BOARD, DLFXR 4Wr OR 1N$rn"UTION)
SPEEDOMETER AUTO
FROM TO MILEAGE
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NATURE OF BUSINESS TRAVELED MILE 41 6-0
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AUTO LICENSE NO. TOTALS 9
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 2
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 claim ly efte wing all just credits r'
and at p o the sam as ee
Date
JUN 0
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must hour kind o f service, its, price performed, dates service rendered, by
whom rate
rates per day, number of hours, N e
Payee Purchase Order No.
Terms
359461 Pittman, Nikeesha Date Due
2713 Highland Place
Indianapolis, IN 46208
Invoice Invoice
Description PO Amount
Date Number (or note attached invoice(s) or bill(s)) 163.89
5122110 Reimb Su lies 26.35
5127110 Reimb mileage 411 4128110
Total 190.24
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
E
Voucher No. Warrant No.
359461 Pittman, Nikeesha Allowed 20
2713 Highland Place
Indianapolis, IN 46208
In Sum of
190.24
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
Po# or Board Members
Dept INVOICE N0. ACCT#fTITLE AMOUNT
1081 -11 reimb. 4239039 163.89 1 hereby certify that the attached invoice(s), or
1081 -11 reimb. 4343000 26.35 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
3 -Jun 2010
Signature
190.24 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund