155335 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 360464 Page 1 of 1
ONE CIVIC SQUARE LINDSAY HOLAJTER CHECK AMOUNT: $22fi.40
y'. o CARMEL, INDIANA 46032 6628 BEAR CREEK DRIVE APT 1424
INDIANAPOLIS IN 46254 CHECK NUMBER: 155335
CHECK DATE: 111012008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4342100 4.15 POSTAGE
1125 4343000 32.25 TRAVEL FEES EXPENSE
1125 R4359000 17978 190.00 GIFT CARDS
PRESCRIBED BY STATE LOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO-
(GOVERNMENTAL UNIT) D EC 2007
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
(1 (J �G�4 SPEEDOMETER
D FROM TO READING NATURE OF BUSINESS MILES M ?a s
qro Q A1 POINT POINT START FINISH TRAVELED P MILE
ro 2u 2oG e e Wry' D n
to I 2u Zook F0 t I i S LO
o I L(o 200 L r Vt r L
I� FT I Vf mi 0 C LA✓ S
S 2
i 1% u r Y
q zoos NVW
o' c �-a e -V m i M 0- o
z 1,0 O�f�h ri 2. u
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t e
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 credits
and that no p art of the same has been paid.
Date d
teas
-3 'lad
Claim No. Warrant No. I have examined the within claim and hereby
IN FAVOR OF certify as follows:
That it is in proper form.
That it is duly authenticated as required
by law
That it is based upon statutory authority.
That it is apparently correct
incorrect
Disbursing Officer
On Account of Appropriation No. for
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Allowed 19� 0 0
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in the sum of
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(Board or Commission) o Ej 0
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p.E. SOYCE CO., INC. MUHCff, IN 01136 Q+
7„:
Carmel Clan r
Parks&Reereatidh Dec 2007
Employee Expense Reimbursement Request
Date of Fund Account Account _ter
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
12 Ib D r fir �t2� �r3ss��� A T u0 S �S
12 D arc, e Sfi CIS rLr �3s°�a 0 (D S
Spy
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: Ts O
Employeen Name (print) Imo!', �a k
Address u(a 4(Y
Check I^
r W
payable to:. City, St, Zip Y} L 5 N q
Signature: Approved by:
Date: Q Date: i
Revised 3 -2 -07 by Business Services;
Shared /Forms and Templates /Business Service Forms /Employee Exp Reimb Request 2007 -3 IT 7Y
U
r 1
Carmel s Ca
Parks &Recreation 101 1. 9 2007
Employee Expense Reimbursement Request -q�r:1�4t Gt -tzW4
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
N i
3%{ u ,)b l 5 w r IS
All receipts should be attached in the same order as listed above. f
No sales tax will be reimbursed. TOTAL: 1
Employeen Name (print) L1 n&v
Address r (A J
Check
payable to: City, St, Zip X M S) 1! u
Signature: l (/✓i Approved by:
Date: I I Date: I II Z' a 7
Revised 3 -2 -07 by Business Services;
Shared /Forms and Templates /Business Service Forms /Employee Exp Reimb Request 2007 -3
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.
Lindsay Holajter Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/21/07 none Mileage reimbursement 32.25
12/18/07 none Holiday party reimbursements- Target 140.00
12/18/07 none Holiday party reimbursements- Starbucks 50.00
11/26/2007 none Post office 4.15
Total 226.40
I hereby certify that the attached invoice(s), or bills) 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.
Lindsay Holajter Allowed 20
In Sum of
226.40
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #ITITLE AMOUNT Board Members
Dept
1125 none 4343000 32.25 1 hereby certify that the attached invoice(s), or
17978F none 4359000_ 190.00 bill(s) is (are) true and correct and that the
1125 none 4342100 4. 15 materials or services itemized thereon for
which charge is made were ordered and
received except
4 -Jan 2008
Sig ure
226.40 Business, Services Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund