HomeMy WebLinkAbout161441 07/11/2008 a CITY OF CARMEL, INDIANA VENDOR: 355133 Page 1 of 1
ONE CIVIC SQUARE AUDREY B KOSTRZEWA
CHECK AMOUNT: $143.54
CARMEL, INDIANA 46032 2592 TURNING LEAF LANE
CARMEL IN 46032 CHECK NUMBER: 161441
CHECK DATE: 7/11/2008
DEPARTMENT ACC PO NU MBER INVOICE NU MBER A DESCRIPTION
1125 4239000 39.90 MISCELLANEOUS SUPPLIE
1125 4342100 5.49 POSTAGE
1125 4343000 98.15 TRAVEL FEES EXPENSE
Carmel o Clay
Parks Retreat' ®n
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
I o o 02e/j* /v 4 1A 39 000 47/rc 3� 9v Asti c f�I er f
4// 7 e !Nark,+" lGl vr,�„� Tra,ej Fees ,C la 3S C-en fence. <vnc -A
4 //1 �O 8 US PS /V t A13 Al 0 Y �s 5 A l 9 Ccr� em- /na, L
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: Jam 1- 7
t
Employeen Name (print) qudi�ey o S�^ze�J� JUN 3 0 2008
Address c2,6 1c1rrj i n a ZC ecp 1. ,3Y
Check
payable to: City, St, Zip
Signature: o Approved by:
Date: c a 7- o� Date: Cvl3� f i�
rvices Division, Revised 3 -2 -07
orms \Staff FormslEmployee Exp Reimb Request
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO ua'y o S7i2 zEr.�l f1
(GOVERNMENTAL UNIT)
R e k 1 ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE. BOARD, DEPARTMENT OR INSTITUTION)
D A SPEEDOMETER
FROM TO READING AUTO MILEA
oW POINT POINT START FINISH NATURE OF BUSINESS TRAVELED C PER MILE r
rtr
MN 3 0 Z098
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AUTO LICENSE NO. 9 90
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 owin all just credits,
end that no part of the same has ben paid.
Date .2 _v
PP
I'
MAY
5 DATE DESTINATION MILEAGE RECORD
/BUSINESS PURPOSE BEGIN ODOMETER
S
MILEAGE
0 I END BUSINESS PERSONAL
me J i s-
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TOTAL
C� N,
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I MILEAGE RECORD
JUNE
I{ 'I MILEAGE
ODOMETER BUSINESS PERSONAL
DESTINATION /BUSINESS PURPOSE BEGIN END
DATE
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TOTAL
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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.
355133 Audrey Kostrzewa Terms
2592 Turning Leaf Lane Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
05/21/08 reimb Meijer Cash containers $39.90
06/17/08 reimb Marker Restaurant Conference lunch $12.35
06/19/08 reimb LISPS Certified mail $5.49
06/30/08 reimb Mileage $85.80
Total 143.54
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.
355133 Audrey,Kostrzewa Allowed 20
2592 Turning Leaf Lane
Carmel, IN 46032
In Sum of
143.54
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 reimb 4239000 39.90 1 hereby certify that the attached invoice(s), or
1125 reimb 4343000 12.35 bill(s) is (are) true and correct and that the
1125 reimb 4342100 5.49 materials or services itemized thereon for
1125 reimb 4343000 85.80 which charge is made were ordered and
received except
30 -Jun 2008
&A-tL ,rYL&�_j
Signature
143.54 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
UD rl Z va MILEAGE RECORD
ODOMETER MILEAGE
DATE DESTINATION /BUSINESS PURPOSE BEGIN END BUSINESS PERSONAL
oI
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4 �m O
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19 A� m L
7/
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MILEAGE RECORD
o�0 U MARCH MILEAGE
I ODOMETER
BEGIN END BUSINESS PERSONAL
i' DATE DESTINATION /BUSINESS PURPOSE S
rn G
t° f c,� o
ry.
3 mC� G
a� o s
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TOTAL
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APRIL MILEAGE RECORD
DATE DESTINATION /BUSINESS PURPOSE ODOMETER MILEAGE l�l 1 BEGIN END BUSINESS PERSONAL
'f
172 C 3
m C A v
s
t 14 k c J-
3
5
U -r'►L' D- x'1'1
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11'
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&4 AFR 10 TOTAL
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