166771 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 355133 Page 1 of 1
ONE CIVIC SQUARE AUDREY B KOSTRZEWA
CARMEL, INDIANA 46032 2592 TURNING LEAF LANE CHECK AMOUNT: $71.97
CARMEL IN 46032 CHECK NUMBER: 166771
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CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
1125 4340600 8.00 RECORDING FEES
1125 4342100 23.60 POSTAGE
1125 4343000 40.37 'TRAVEL FEES EXPENSE
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Carmel Clay
Parks &Recreation
Employee Expense Reimbursement Request
Fund Account Account
Date of Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
9/17/2008 Hamilton County Recorder 1125 4340600 Recording Fees 8.00 Document recordin
11/20/2008 US Post Office 1125 4342100 Postage 23.60 Stamps for Admin
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
Employee Name (print) AUDREY KOSTRZEWA
Address 2592 Turning Leaf Lane
Check payable
to: City, St, Zip Carmel, IN 46032
Signature: s�1J� Approved by:
z
Date: a�� J Date:
Business Services Division, Revised 7 -7 -08 r.
FILE: SharedWdministrative \Forms \Staff Forms \Employee Exp Reimb Request
NOV 2 -4 2008
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO 101 (19BS)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INsnrUTiOI,j
FROM TO SPEEDOMETER
DATE READING AUTO MILEAGE
z0 L�z NATURE OF BUSINESS MILES CT 72 ,'�l a
POINT POINT START FINISH TRAVELED PER MILE
e /YI a lJ774Y1 SAC'
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VX
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. C9
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 legal e, after aliowing all �cre
end that no part of the same s been paid.
Date
�o
'3 DlJ O l
NOV 2 4 2008
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MILEAGE RECORD
i AUGUST
ODOMETER MILEAGE
DATE DESTINATION /BUSINESS PURPOSE BEGIN END BUSINESS PERSONAL
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F,
SEPTEMBER MILEAGE RECORD
ODOMETER MILEAGE
DATE DESTINATION /BUSINESS PURPOSE BEGIN END BUSINESS PERSONAL
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OCTOBER MILEAGE RECORD
DATE DESTINATION /BUSINESS PURPOSE ODOMETER MILEAGE
hi BEGIN END BUSINESS PERSONAL
P 177
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MILEAGE RECORD
NOVEMBER VEMBER
ODOMETER ERSONAL
�'r I DATE DESTINATION /BUSINESS PURPOSE BEGIN END gU51NE55 P
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TOTAL
I &I AFR 10
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized
ratmust show; kind d of serfice, units, price performed,
unit dates service rendered, by
whom, rates per day number of hours,
Payee Purchase Order No.
Terms
355133 Audrey Kostrzewa Date Due
2592 Turning Leaf Lane
Carmel, IN 46032
Invoice Invoice Description A mount
Date Number (or note attached invoice(s) or bill(s))
$8.00
11/21/08 reimb Recording fees $23.60
11/21/08 reimb Postage $40.37
11/26/08 reimb Mileage Aug,Sep,Oct,Nov'
Total 71.97
I 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
71.97
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 reimb 4340600 8.0 1 hereby certify that the attached invoice(s), or
1125 reimb 4342100 23.60 bill(s) is (are) true and correct and that the
1125 reimb 4343000 40.37 materials or services itemized thereon for
which charge is made were ordered and
received except
G
1 -Dec 2008
Signature
71.97 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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