155700 01/23/2008 CITY OF CARMEL, INDIANA VENDOR: 360417 Page 1 of 1
ONE CIVIC SQUARE JESSICA DAVIS
CARMEL, INDIANA 46032 CHECK AMOUNT: $118:92
CHECK NUMBER: 155700
CHECK DATE: 1/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4239037 51.99 CLUB ACTIVITY SUPPLIE
1046 4343000 66.93 TRAVEL FEES EXPENSE
,j
car'me� Clay JAN 0 A 2008
1RO 06's
Parks &Recreation
Employee p
Expense Reimbursement Request I�� u
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amo Purpose of Expense
�011 Qush 1 io 4 a�3� D ubslilx d vc�� I U
1p�
jOL4W qzEufl U S )IIII k" qW,5'CP/P�IU"'bSLTIP
I'a '9IOC ,bU.St 1 ®4� 42n o3l HMf
D i 0�,1 r�cJL Z3�n 3� b
L�4 2A U I hl
1 Cp 423�ua� l 1H.q(o
11 PSG rsh l4 INLO 4z3��3� OOS t l�3- a'1
.O L�
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
Employeen Name (print).jt�gic
Address SVrn b r•
Check
payable to: City, St, Zi ry� o
SignatuCp,_;—. Approved b
M Date: V Date: U
Revised 3 -2 -07 by Business Services;
Shared /Forms and Templates /Business Service Forms /Employee Exp Reimb Request 2007 -3
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FOAM NO. 101 (1986)
MILEAGE CLAIM
DEPT v 7 2 TO AepcobwLs
(GOVERNMENTAL�UNIT) r,, 1-• j
I �V V ON ACCOUNT OF APPROPRIATION NO. FOB �Z? r i
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION) r .t'�G�IJ
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE
NATURE OF BUSINESS MILES J S
1 9 POINT POINT START FINISH TRAVELED PER MILE
Ito
lu
4
UJ
)9 M- n hn :E�f I P�y 73
LA
MW
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 allow' g--a l just credits
and. that no part o the same has been paid.
Date la Im
PRESCRPBED BY STkTE BOARD OF ACCOUNTS I T7
F Q q}a,M GENERAL FORM NO. 161 (1986)
DEPT MILEAGE CLAIM "I� JAN 0 2008
A I J"13 0 0 0 TO I
(GOVERNMENTAL UNIT) 'r
DESC �1 ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION) V� f
DATE FROM TO SREEDOMGET +R
MILES
AUTO MILEAGE
19 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED 4F r
PER MILE
M001 JV-V-i)DK-
la It I=Ur r mna if-ej- 9Z X_U_ L f.
ICA
r
I
AUTO LICENSE NO. TOTALS' V
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 d after allowing all just credits
end that no part of the same has been paid.
Date
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.
Jessica Davis Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/3/07 reimb. Club supplies 51.99
12/21/07 reimb. Mileage reimbursement 37.83
12/21/07 reimb. Mileage reimbursement 29.10
Total 118.92
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
Voucher No. Warrant No.
Jessica Davis Allowed 20
In Sum of
118.92
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 reimb. 4239037 51.99 1 hereby certify that the attached invoice(s), or
1046 reimb. 4343000 66.93 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
17 -Jan 2008
Sig ature
118.92 Business Services Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund