163767 09/17/2008 CITY OF CARMEL, INDIANA VENDOR: 358411 Page 1 of 1
ONE CIVIC SQUARE JENNIFER HAMMONS CHECK AMOUNT: $406.96
CARMEL, INDIANA 46032 1847 WELCHWOOD CR, APT 289
INDIANAPOLIS IN 46260 CHECK NUMBER: 163767
CHECK DATE: 9/17/2008
D ACCOUN P O NU I NVOICE NUMBE AMOUNT DESCRIPTION
1046, 4239037 67.66 CLUB ACTIVITY SUPPLIE
1046' 4343000 339.30 TRAVEL FEES EXPENSE
Y'
carmen 0 03
Pau ks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
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2 g rye r� a nc� C \mob less -ar"
O 1 I S e �9 (0 G +_x o c m S �ie5
All receipts should be attached in the same order as listed above. r
No sales tax will be reimbursed. TOTAL:
E�VE
Employeen Name (print) AUG 2 1 2008
Address V y i C�t��► C� Zg�
Check A1 BY:
payable to: City, St, Zip
x
Signature: Approved by:
i U
Date: Date:
v
Business Services Division, Revised 3 -2 -07
FILE: Shared\Administrative \Forms\Staff Forms \Employee Exp Reimb Request
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110. 101 11986)
MILEAGE CLAIM
TO —n �'V11'Yl�'Yi
(GOVERNMENTAL UNI'n
ON ACCOUNT OF APPROPRIATION NO. FOR
(OMCE BOARD, DEPARTMENT OR 1NSrMfr10N)
SPEEDOMETER
DATE FROM TO I READING AUTO AULEAGE C
NATURE OF BUSINESS
Za PAINT POINT STAA7 FINISH 1'AAVELED
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, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just dits
end that no part of the same has been paid.
Date Zh 2
S E P 0 2 2008
BY:
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.
358411 Jennifer Hammons Terms
1847 Welchwood Cir 289 Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/12/08 Reimb. Supplies 67.66
8/29/08 Reimb. Mileage 8/1/08 8/29/08 339.30
Total 406.96
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
i
Voucher No. Warrant No.
358411 Jennifer Hammons Allowed 20
1847 Welchwood Cir 289
Indianapolis, IN 46260
In Sum of
406.96
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4239037 67.66 1 hereby certify that the attached invoice(s), or
1046 Reimb. 4343000 339.30 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
2 -Sep 2008
Signature
406.96 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund