178109 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 360417 Page 1 of 1
ONE CIVIC SQUARE JESSICA DAVIS CHECK AMOUNT: $93.34
i, CARMEL, INDIANA 46032
CHECK NUMBER: 178109
CHECK DATE: 10/14/2009
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
,1046 4239037 REIMB 17.44 CLUB ACTIVITY SUPPLIE
•1046 4343004 REIMB 75.90 TRAVEL PER DIEMS
Carmel C) Clay
Parks &Recreati ®n
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
'l(0 I -0
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
Employee Name (print) t V Is
Address C
Check
payable to: City, St, Zip �j
Signature: Approved by:
Date:
Date: 10
Business Services Division, Revised 7 -7 -08
FILE: SharedlAdminislrative lFormslStaff FormslEmployee Exp Reimb Request
PRrSCRIBCD BY STATE BOARD Of ACCOUNTS CINF..PAL romm i1G. 101 Vlae
MILEAGE CLAIM
TO
EUINENrALuNm
F.X�NDIED Sc,Nr� u a�ffa�r(T ON ACCOUNT OF APPROPRIATION Nfl, FOR
(OMCP. BAD. DEPAATIEEKT OR INST 710M)
FROM TO SPEEDOMETER AUTO AGE
DATE READING
2-0 POINT POINT START FINISH NATURE OF BUSINE56 TRAVELED 4
PER MILE
I ti I I 8
AI I 4
i I I I I
[g I I
l I I I i I
I I i i I
I I I
\f
v t y, v
l
AUTO LICENSE NO, Y 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 1S5, Acts 5953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits
end that no part of the same has been paid.
Date
vv —5 9
Tf c r
c oo 7
i .an....o.,.a.aa000 a..a•
Jn' Y
A u�A-�
P"SCRIBLD BY STATt HOARD Of ACCODNTH Gtsr-AL'ORW oc. IDI (1900
MILEAGE CLAIM
Tp
CAKWEI- 1 L AS{ S_ -A" C r
(oovrxNN TALi'M ON ACCOUNT OF APPROPRIATION NO. FOR 1�_ t 1� is
ExYENDE'b L 6B�tt�Et�
(OF ICR, BOARD, DEPAATM37IT OR IN ION)
FROM TO SPEEDOMETER
DATE BEADING AUTO AGE
2 POINT POINT START MISH NATURE OF BU9INFSS TRAVELED r
PER MILE
1/�I l 1:2
f I r I I
I I
L/ I I I I I
I I I
iri In 1 I
�7
$A 7 P
V
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing -all just cre
end that no part of the same has been paid. VJ
Date
0 0 OCT U 1009
Y�
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FOAL PO. 101 (ine
MILEAGE CLAIM TO
LM PA K.S M►1>P Il.111 kJ
(OOVEANNENTAL Ut +m ON ACCOUNT OF APPROPRIATION NO. FOR
CxrESDED
(OF, ICE. BOARD. DEPAAru:KT OR IN lON)
FROM TO SPEEDOMETER AUTO AGE
DATE READING
La
POINT POINT START FINISH NATURE OF BUSINESS TRA FLED r
PER MILE
I
j
i
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is 1 11 r due, after al w' 11 t re 'ts
end that no part of the same has been paid.
Date
poo(-
OCT 0 6 10'09
;r; :7
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
360417 Davis, Jessica Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10!5109 Reimb. Club supplies 17,44
1015/09 Reimb. Mileage 619 9125109 75.90
Total 93.34
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
360417 Davis, Jessica Allowed 20
In Sum of$
93.34
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4239037 17.44 1 hereby certify that the attached invoice(s), or
1046 Reimb. 4343004 75.90 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
7 -Oct 2009
Signature
93.34 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund