HomeMy WebLinkAbout166278 11/24/2008 CITY OF CARMEL, INDIANA VENDOR: 362128 Page 1 of 1
0 ONE CIVIC SQUARE JEFFREY KOZLOVICH CHECK AMOUNT: $44.50
CARMEL, INDIANA 46032 10465 HARLOW DRIVE
FISHERS IN 46038 CHECK NUMBER: 166278
CHECK DATE: 11/24/2008
DEPARTMENT ACCOUNT PO N UMBER INV NUMBER AMOUNT DESCRIPTION
651 5023990 44.50 OTHER EXPENSES
of
CITY OF CARMEL Expense Report (required for all travel expenses)
�HD I ANj�
J
2008 mileage reimbursement rate is 58.5 cents /mile
EMPLOYEE NAME: Jeffrey Kozlovich DEPARTURE DATE: na TIME: AM PM
DEPARTMENT: Utilities /Sewer RETURN DATE: na TIME: AM PM
REASON FOR TRAVEL: DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT _X_ TRAVEL PER DIEM
Transportation Gas/Tolls/ Meals
Date Parkin Lodging Misc. Total
Air -fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
10/9/08 $14.50 $30.00 $44.50
10/9/08 $0.00
assed IDEM's wastewater treatment p lant operator certification class I exam $0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.0
$0.00
$0.00
0.00
Total $0.001 $0.001 1.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.00.
DIRECTOR'S STATEMENT: I hereby affirm that all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date:
City of Carmel Form ER06 Revision Date 11/14/2008 Page 1
Chase Online Check Details https: //banking. chase. com Statements /Checklmage.aspx ?PageSourc...
Chase Online
CHASE FREE CHECKING (...6102)
Check Number: 1145 Post Date: 08/28/2008 Amount of Check: $30.00
JEFFREY G. KOZLOVICH 07-a5 '1: 129 1145
JEFFREY G. KOZLOVICH =156102
1 0465 HARLOW DR.
FISHERS, IN 46038 OWE
P AY
ORDER NbI :4rV P PP o� �nJronr� r
OO
ao ^N 30.
16"t jok'U S oounas 8
KI®NE.
&Morgan Chase Bank NA
Ir%ftnepo&% &XWM 48M
MEMO
1:0740000 W4 70015 0 2110 X45 e. 09 300�C
Need help printing or saving this check?
T
5 r-
O T J
y n Z
m
Need help printing or saving this check?
2008 JPMorgan Chase Co.
1 of 1 11 14/2008 12:27 PM
VOUCHER 086721 WARRANT ALLOWED
T1055 IN SUM OF
KOZLOVICH, JEFF
CARMEL WASTEWATER
Carmel Wastewater .Utility
,,,ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
100908 01- 7042 -06 $44.50
Voucher Total $44.50
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T1055
KOZLOVICH, JEFF Purchase Order No.
r
CARMEL WASTEWATER Terms
Due Date 11/18/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/18/2001 100908 $44.50
r
pv�t-
hereby certify that the attached invoice(s), or bill(s) is (are) true and
:orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Ofvflr