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Home My WebLink About194114 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1 ONE CIVIC SQUARE TIFFANY BUCKINGHAM CARMEL, INDIANA 46D32 5130 PRIMROSE AVE CHECK AMOUNT: $98.50 INDIANAPOLIS IN 46205 CHECK NUMBER: 194114 CHECK DATE: 2/3/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4239039 16.00 GENERAL PROGRAM SUPPL 1061 4343000 82.50 TRAVEL FEES EXPENSE PRESCRIBED By STATE BOARD OF ACCOUNTS GENERAL FORM No. 101 (1986) MILEAGE CLAIM 'T l -f' 4 e� TO 9- 2 yctA 1.1.NMENTAL UNI'[) ll 1 ON RECOUNT OF APPROPRIATION NO. FOR tOFiICE, BOARD, DEPARTMENT OR 1NST=ION) SPEEDOMETER DATE FROM To READING .f NATURE OF BUSINESS MIL AL POINT POINT START FINISH TRAVELED PER WLE NN Eo C L t C G 1 0C v LC-j)-e Cr 0>'10 i AUTO LICENSE NO_ TOTALS SPEEDOMETER READING columns are to be used only when distance between points cannot he determined by fixed mileage or official highway map. Pursuant to the provisions and penalties of Chapter 155, Acts 1953, f 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 F vn J /n/ t✓4 JAN 0 7 2011 L DO«AR TREE STORES INC.,, Store# 2092 (317) 255 -8611 7225 North Keystone Ave Suite D Indianapolis IN 46240 DESCRIPTION OTY PRICE TOTAL OATMEAL /HONEY BATH 1 1.00 1.00N DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 1.00N _`DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 I. OON DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 1.00N DISHPAN 1 1.00 1.00N Sub Total $16.00 SALES TAX $0.00 Total $16.00 Cash $20.00 CHANGE -4.00 Tax Exempt ID 0119683083 Thank You for Shopping at Dollar Tree Where Everything's $1.00 Now Shop On -Line at Dollartree.com 002147 2092 04 00041 83004 1/05/11 11:56 Sales Associate: Teanna CASH 1Pod [iaROMES available to be WON ®AOLY2 r To see PREVIOUS WINNERS complete rules please visit www.dollartreefeedback.com Apple iPo& prize value of $200 per day. Fod" is a registered trademark of Apple Inc All rights reserved. Apple is neither a participant in nor a sponsor of this promotion. So that we may continue to provide you extreme value, we reserve the right to limit quantities, do not offer refunds and consider all sales final. We will gladly exchange any unopened item with original receipt Sony no exchanges on seasonal merchandise. You could INSTANTLY an PLUS receive 0 0 C�HAMC�[ES to `W` 0 by completing our Customer Satisfaction Survey at a d000��t�a�c�c�{�c�c�db��C�oe ®o� CASH albod PROXIES available to be WON DAUM OR receive I chance to win $1,000 by calling 1- 866 -514- 1935._ To see PREVIOUS WINNERS complete rules please visit www.dollartreefeedback.com Apple Pod" prize value of $200 per day. iPod® is a registered trademark of Apple Inc. All rights reserved. Apple is neither a participant in nor a sponsor of this promotion. So that we may continue to provide•you extreme value, we reserve the right to limit quantities, do not offer refunds and consider all sales final. We will gladly exchange any unopened item Carmel o Clay P arks &Recreate ®n Employee Expense Reimbursement Request Date of Fund Account Account Receipt Vendor listed on receipt Line Budget Description Am Purpose of Expense 5 o� j f-ee S o? �g 1 r _y z3U3� ey�2fa rod �a/n 5 v N 7 00 su lr`�s %G�ul� All receipts should be attached in the same order as listed above. J No sates tax will be reimbursed. TOTAL: t t Employee Name (print) o a! "�a o Check Address payable to: City, St, Zip vicA l 5 1 L402-OS Signature: jz� Approved by: Date: f Date: Business Services Division, Revised 7 -7 -08 q FILE: Shared\Administrative\Forms \Staff Forms\Employee Exp Reimb Request t—` J AN 1 201 1 ��7 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. 358408 Buckingham, Tiffany Terms 5130 Primrose Ave Indianapolis, IN 46205 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 12120/10 Reimb. Mileage 11119 12/20/10 82.50 115111 Reimb. Program supplies 16.00 Total 98.50 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_ 358408 Buckingham, Tiffany Allowed 20 5130 Primrose Ave Indianapolis, IN 46205 In Sum of 98.50 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members Dept 1081 -2 Reimb. 4343000 82.50 1 hereby certify that the attached invoice(s), or 1081 -2 Reimb. 4239039 16.00 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 27 -Jan 2011 Signature 98.50 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund