HomeMy WebLinkAbout202968 10/25/2011 CITY OF CARMEL, INDIANA VENDOR: 363065 Page 1 of 1
ONE CIVIC SQUARE JAMES DOWELL
CARMEL, INDIANA 46032 C/O PARKS ESE CHECK AMOUNT: $664.14
yr �o CHECK NUMBER: 202968
CHECK DATE: 10/25/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 42.14 GENERAL PROGRAM SUPPL
1081 4343000 REIMB 229.59 TRAVEL FEES EXPENSE
1082 4343000 REIMB 392.41 TRAVEL FEES EXPENSE
PRMAIOED UT STATE BOARD OF ACCOUNTS ar.NFAAL FORM NC IN 1'"')
MILEAGE CLAIM
R �Sfi TO__ V 6M ZS
IE30vrA rAI. ul+m
ON ACCOUNT OF APPROPRIATION NO. FOR
(OrFICE. HOARD. DUART.rENT OR INSTITUTION)
UATE FROM TO SPFE +E AUTO MILEAGE
2a POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
YEA M ILE
a -tx> m c r G w
o c JJ
C
a-a Cw
1 o
to 't
1 0 A.
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AUTO LICENSE NO. TOTALS k i
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to lire provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct. that the amount claimed is gall due, afte ioA g all )ust credit
and that no art o the same has been paid.
Date
J
1 J^
J
PU=RIBED BY STATL BOARD OF ACCOUNM GEXUAL 'OAM 110 M (Mn
MILEAGE CLAIM
CPR TO--_q JCJ
IGOVERXMENrAL UNITI ON ACCOUNT OF APPROPRIATION NO- FOR
[W710E, BOARD. DLPARTAC:NT OR 1"SrnUNQ8)
SPEEDOMETER
DATE FROM TO READING AUTO MILEAGE EAGE
ZO
NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED
16 PER M
1 9 J
14 J6V
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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 claimed is egally e, niter aliowv all )US( credits
end that no qart of I h carne has been paid, J
Date
7
e
ocr
A 7 3
FN_,CRIDEU BY STATE BOARD OF ACCOUNi1 GENFAAL FORW NG IN M5)
MILEAGE CL
(GOVERH.EN AL UNm ON ACCOUNT OF APPROPRIATION NO. FOR
(OMCE. BOARD. DUAR11tEXT OR INSI ION)
FROM TO SPEEDOMETER AUTO WLEAGE
DATE READING
zd L
MILES
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED c
PER MILE
7 12x. 00
1_ r
w .6 1
Cc L. (Mb ne
LA
3 O
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41 j&o
o
2.-L 'j 1&0 0
AUTO LICENSE NO. 1
TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 3l�
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 claimed is egally ue, after a ving tttt a nnnn U just credit
end that no ppri �o tfm same has been paid.
Dat
g
Oc
PRFSC—Ea By STATE BOAhD OF ACCOWM GEXUAL FORM 1 301 IMF)
MILEAGE CLAIM
TO_ b o
F-
(GO�ERN."rAL UNM ON ACCOUNT OF APPROPRIATION NO. FOR
MCE. BOARD, DEBAR -WiT OR INSTTFUTIDN)
PFEDOMETER
DATE FROM TO READING 4- AUTO WLEAGE
NATURE OF BUSINESS MILES 0
POINT t POINT START FINISH TRAVELED PER MILE
I— A?-a
MCC e
(0 7 c 1 5-3 --7
4 1 'A 1 15, 15 7
65
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AUTO LICENSE NO, TOTALS 19 zs V
SPEEDOMETER READING columns are to he 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 claimed is eg ly due, after li ving 11 just cre s
and that no rt of1he has been paid.
Date C�
q 0
V��
Carmel o Clair
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
g Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
1OV- Y�390. r4e,S'j (e5 l CJu6 6=11
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
Employeen Name (print) J0.rne5 �O we l 1
Address
Check
payable to: City, St, Zip A y 6 Zv
Signature: Approved by:
Date: I D 1 I h Date: l
Business Services Division, Revised 3 -2 -07
FILE: SharedWdministrative \Forms \Staff Forms \Employee Exp Reimb Request
V
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.
363065 Dowell, James Terms
14328 Banister Dr
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10/17/11 Reimb. Mileage 6/6 8/24 -11 392.41
10/17/11 Reimb. Mileage 8/25 10/14/11 229.59
10/18/11 Reimb. Supplies 42.14
Total 664.14
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
Voucher No. Warrant No.
363065 Dowell, James Allowed 20
14328 Banister Dr
Noblesville, IN 46060
In Sum of
664.14
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members
Dept
1082 -1 Reimb. 4343000 392.41 1 hereby certify that the attached invoice(s), or
1081 -3 Reimb. 4343000 229.59 bill(s) is (are) true and correct and that the
1081 -3 Reimb. 4239039 42.14 materials or services itemized thereon for
which charge is made were ordered and
received except
20 -Oct 2011
Signature
664.14 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund