HomeMy WebLinkAbout200470 08/17/2011 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
4 ONE CIVIC SQUARE SHAVONNE HOLTON
CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 3B CHECK AMOUNT: $183.52
y`llah/ INDIANAPOLIS IN 46208 CHECK NUMBER: 200470
CHECK DATE: 811 712 01 1
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMS 51.00 TRAVEL FEES EXPENSE
1082 4239039 REIMB 66.16 GENERAL PROGRAM SUPPL
1082 4343000 REIMB 66.36 TRAVEL FEES EXPENSE
Carmel o Clay
Parks
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
11 C LO su 8 s
k oSz-
_7 z t �O mar (_0 2- ,G
tl�
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
el— Employee Name (print Ayn n QCi, IiAn VA t`� C)
Check Address 302 B o-�-V Lr A P-" Q
payable to: City, St, Zip
Signature Approved by:
Date: 7 Date:
Business Services Division, Revised 7 -7 -08
FILE: Shared \AdministrativetFormsistaff FormslEmployee Exp Reimh Request
PRESCRIBLD BY STATE BOARD OF ACCOUNTS GENERAL FORM 140. 10) 11"q
MILEAGE CLAIM
(GOVERNMENTAL UNIT) —T
ON ACCOUNT OF APPROPRIATION NO. FOR
(Of7CE, BOARD, DYPARTORr OR INSTTTUT[oN)
SPEEDOMETER
DATE FROM TO I READING AUTO MILEAGE
Za 1-t- NATURE OF BUSINESS MILES 5 D
POINT POINT START FINISH TRAVELED PER MILE
x
CM s
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enc. a
no x
m Y�
r ,x
A Al
MCC
1 C CL MCC
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I A
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1 i n 1 7 rn m or Cct r-
A 02 X
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X
C 11 t x
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 claime eg 1 y d e, of r Ii ing all just credit I
and that no of he same has been paid.
Date
04 7 W Q
]BYo
PRESCRIBED By STATE BOARD OF ACCOUNTS GENERAL FORM IIG. 181 11986)
MILEAGE CLTOIMj V�� Q 4 f,'b n
(GOVERNMENTAL UNIT) 1 ii tT`ll
ON ACCOUNT OF APPROPRIATION NO_ FOR
(OF, HOARD, DEPART6a2,7 OR 1NSITT1rrION)
FROM TO SPEEDOMETER AUTO E
2 D1�TE I READING ES
1 I L POINT PORJT START FINtSN NATURE OF BUSINESS TRAVELED PER iliLE
I I
I VC
1
rC]
t
X56 5�}
n
r �o
MCC
u r
t
w rX I 1. 77
nr1c, r 1 C ,10
I'
AUTO LICENSE NO. TOTALS 4 Z
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, Picts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, aft aliowing all just credits
end that n 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.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
7/20111 Reimb. Costumes 66.16
7/25/11 Reimb. Mileage 512 5/31111 51.00
7125111 Reimb. Mileage 617 7/13/11 66.36
Mileage 311 4125111
Total 183.52
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
1
Voucher No. Warrant No.
360926 Halton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of
183.52
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1082 -6 Reimb. 4239039 66.16 1 hereby certify that the attached invoice(s), or
1081 -1 Reimb. 4343000 51.00 bill(s) is (are) true and correct and that the
1082 -6 Reimb. 4343000 66.36 materials or services itemized thereon for
which charge is made were ordered and
received except
9 -Aug 2011
Signature
183.52 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund