189703 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
ONE CIVIC SQUARE TIFFANY BUCKINGHAM
CARMEL, INDIANA 46032 5130 PRIMROSE AVE CHECK AMOUNT: $147.46
INDIANAPOLIS IN 46205
CHECK NUMBER: 189703
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 9.96 GENERAL PROGRAM SUPPL
1082 4343000 137.50 TRAVEL FEES EXPENSE
IRLSCRI6ED BY STATE BOARD OF ACCOUNTS
cLNERAL FORW NO 101 119661
MILEAGE CLAIM
To
if GOYEANM EN7�l r j,rtlN1T1
J ON ACCOUNT OF APPROPRIATE N NO. FOR
(OMCE, ARD,� CR INSTiMION)
SPEEDOt /ET£Fi
AUTO
DATE FROM TO I READING IuS E c
NATURE OF BUSINESS
Za 3 POINT POINT START FINISH TRAVELED PER MILE
2- a( 1 Kid
r
a� -291
I T PA vrttn S e
Gl 1 CL IAA f O (7
OY
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a
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. `J
11 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 ahowing all just credits
and that no part of the same has been paid.
Date
AU6 2 5 2010
B70.......................
r.
Carmel o Clay
Parks &Recreati
Employee Expense Reimbursement Request
Date of Fund Account Account
R Vendor listed on receipt Line Budget Description Amouunt Purpose of Expense
Vje(OL( ro (am f r('� f 1 4 e Gl-
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
Employee Name (print) AUG 2 5 ZQ
Address
Check
payable to: City, St, Zip Vlf y �Z4S
Signature: Approved by
Date. Date I
>A
Business Services Division, Revised 7 -7 -08
FILE: Shared \Administrative%Forms\Staff Forrns�Employee 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.
Terms
358408 Buckingham, Tiffany
5130 Primrose Ave
Indianapolis, IN 46205
Invoice Invoice Description PO Amount
Date Number (or note attached invoice(s) or bill(s))
137.50
8120110 Reimb. Mileage 618 8120/10 9.96
8120110 Reimb. Program supplies
M Total$
I 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,
358408 Buckingham, Tiffany Allowed 20
5130 Primrose Ave
Indianapolis, IN 46205
In Sum of$
147.46
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1082 -1 Reimb. 4343000 137.50 1 hereby certify that the attached invoice(s), or
1081 -2 Reimb. 4239039 9.96 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
9 -Sep 2010
Signature
147.46 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund