162833 08/20/2008 CITY OF CARMEL, INDIANA VENDOR: 355133 Page 1 of 1
g 0 ONE CIVIC SQUARE AUDREY B KOSTRZEWA CHECK AMOUNT: $22.89
CARMEL, INDIANA 46032 2592 TURNING LEAF LANE
o� CARMEL IN 46032 CHECK NUMBER: 162833
CHECK DATE: 8120/2008
DEPARTMENT ACC OUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1 4342100 7.09 POSTAGE
1125 4343000 15.80 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 410. 101 (1986)
MILEAGE CLAIM U Z S Z L W 7t
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. �d FOR
(OFFICE, BOARD. DEPARTMENT OR INSTTTUTION)
DATE FROM TO BEADING ER
b AUTO MILEAGE
POINT POINT START FINISH NATURE OF BUSINESS
PO TRAVELED
PER MILE
g
,O
G A-d
a C-
11 5--
AUTO LICENSE NO. TOTALS a Qv
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. v
Pursuant to the provisions and penalties of Chapter 155, Acts 1053, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after alto ving all just credits
and that no part of the same has been paid.
Date
//OR
AIL a
��v� 7P vo-
Carmel A Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
7/18/2008 US Postal Service 101 -1125 4342100 Posage 7.09 Certified Mail
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: 7.09
=BY: Employee Name (print) Audrey Kostrzewa Address 2592 Turning Leaf Lane
Check
payable to: City, St, Zip Carmel, IN 46032
Signature: Approved by:
Date: c3 Date: f sQ
Business Services Division, Revised 7 -7 -08
FILE: Shared \Administrative \Forms \Staff Forms \Employee Exp Reimb Request
t�.
..t
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
07/31/08 reimb Mileage July 08 $15.80
07/31/08 reimb USPS Certified mail $7.09
l
l_
Total 22.89
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
22.89
ON ACCOUNT OF APPROPRIATION FOR
101 Genera! Fund
PO# or INVOICE NO. ACCT#ITITLE AMOUNT Board Members
Dept
1125 reimb 4343000 15.80 1 hereby certify that the attached invoice(s), or
1125 reimb 4342100 7.09 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
1 -Aug 2008
Signature
22.89 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund