197577 05/26/2011 emu,, CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
s ONE CIVIC SQUARE TIFFANY BUCKINGHAM CHECK AMOUNT: $93.85
CARMEL, INDIANA 46032 5130 PRIMROSE AVE
INDIANAPOLIS IN 46205 CHECK NUMBER: 197577
CHECK DATE: 5126/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 25.00 GENERAL PROGRAM SUPPL
1081 4343000 REIMB 68.85 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GFNFIIAL FORM 110. fM I14B6)
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SPEEDOMETER AUTO MILEAGE
DATE FROM To I READING NATURE OF BUSINESS MILES
2- POINT POINT START FINISH TRAVELED PER MILE
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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, 1 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 1
Sol r 1 9 lam,
SAY 1 1071
BY:
Carm n Clay
Parks& Re creation
Employee Expense Reimbursement Request
Date of Fund Account Account
n Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
1 (a Z CV�e(ct[ S (r f j .OQ xlz c e i ems, d�
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
r:
Employee fume (print) V\ Gt /I C ZQ�
S� L t1 b
Address �C�S C \r'.
Check BIB.
payable to: City, St, Zip 6
Signature: Approved by:
Date: �j Date
Business Services Division, Revised 7 -7 -08
FILE: Shared%Administrative%Forms %Staff Forms\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,
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
5118111 Reimb. Mileage 4125 5/16/11 68.85
519111 Reimb. Site celebraton 25.00.
Total 93.85
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
93.85
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept
1081 -2 Reimb. 4343000 68.85 1 hereby certify that the attached invoice(s), or
1081 -2 Reimb. 4239039 25.00 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
19 -May 2011
Signature
93.85 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund