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HomeMy WebLinkAbout178042 10/14/2009 °M CITY OF CARMEL, INDIANA VENDOR: 360484 Page 1 of 1 ONE CIVIC SQUARE AMY BALDAUF a CARMEL, INDIANA 46032 126 LARK DR CHECK AMOUNT: $805.66 APT D CHECK NUMBER: 178042 CARMEL IN 46032 CHECK DATE: 10/14/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1046 4239040 REIMB 240.48 FOOD BEVERAGES 1046 4343004 REIMB 565.18 TRAVEL PER DIEMS Carmel C) Clay Parks &Recreatidn Employee Expense Reimbursement Request Date of Fund Account Account Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense 9 6 9 0 0 b ck 'M vt All receipts should be attached in the same order as listed above. r No sales tax will be reimbursed. TOTAL: U Employee Name (print) Address 12 LCkYY, 'DY, 0CT 0 6 2009 Check payable to: City, St, Zip G AMY 2 Signature: 0 0 M n a Approved by: Date: Date: Business Services Division, Revised 7 -7 -08 FILE: Shared\Administrative%Forms \Staff Forms \Employee Exp Reimb Request IBER.PRT 14490 Clay Terrace BLVD Carmel In 46032 Host: Luz 09/18/2009 TM1240 12:57 PM REPRINT# 1 10141 GR. SIRLOIN LRG (7 @12.29) 86.03 CHICKEN LRG (5 @12.89) 64.45 CAT BAG CHIPS (6 @15.00) 90.00 subtotal 240.48 Tax Exempt #0119683083 0.00 Tax 0.00 TO GO Total 240.48 MC 240.48 Auth:77866B check Closed C) 'CJ Page 1 PRESCRIBED BY STATE BOARD Or ACCOUNTS C"r.RAL FORM NO. 10) PnB) E CLAIM 0 TO ff4 (GOVERNMENTAL UNM [[yy ON ACCOUNT OF APPROPRIATION NO. FOR (OP,ICE, BOARD, DEPARTItEXT OR INSTMuTION) 71 78+ �IIAFE, FROM 66 55+ SREAD READING AUTO MILEAGE POINT 7 2 60+ RT FINISH NATURE OF BUSINE56 MILES i 5 c TAAVELEO PER MILE 60 °50+ t iffln v 5 44 °80+ 29 °70+ 5 ri G 70 1 3+ ,p 4h` ALL) I 11 69° 58+ 565 °18* 2 k ZZ A N C AUTO LICENSE NO- TOTALS SPEEDOMETER READING columns are to be used only when distance between points cannot he 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 aliowing all just credits and that no part of the same has been paid. Date r OCT Inno Q 6 2009 C; PMCRIBE13 By STATE BOARD OF ACCOUNTS GENERAL FORS NO. 101 1 19 MILEAGE CLAIM TO tGOVERNMENTAL UNM ON ACCOUNT OF APPROPRIATION NO. FOR tOFiSCE, BOARD, OEPART(EKT OB INSTLnJr2OF0 SPEEDOMETER 1) FROM To READING t AUTO E 2(1 NATURE OF BUSINESS MILES POINT POINT START FINISH TRAVELED PER MILE 77 J ao d on oti S lii'lUCi 2_ vi n n S 1 n S ;v D' "2 Oil 10 Je Munc 11 AUTO LICENSE NO. TOTALS ,Z1t V 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 al'owin aU just ore 'ts and that no part of the same has been paid. Date OCT 0 6 2009 PMCRIBED BY STATE BOARD OF ACCOUNTS GF1tF.RAL FORM 110. 101 lllree) MILEAGE CLAIM TO (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR (OFFICE, BOARD, DEPARTMINT OB 1XS=LON) sP�ooMtrrEA FROM TQ I T READING NATURE OF BUSINESS MIL CcL 7 NA o zoB ppplT POINT START FENt3H 7AAUf91 pER MILE S no S i S_ 1 S Nlb, \uO 11p tv o n i NAfzL- S 5 u Z j k- Mar Mat- l� (`►l 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 due, after aliowing ail just credits and that no part of the same has been paid. Date OCT 4 6 1009 PRESCRIBED BT SPATE BOARD OF ACCOUNTS GENERAL FORM ]PO ICI 71986] MILEAGE CLAIM so {GOVERNMENTAL UNIT} ON ACCOUNT OF APPROPRIATION NO. FOR (OFFICE, BOARD- DEPARTWENT OR IMSTnUTION) BPEEDOMETFIt FROM TO DATE READING READING AUTO MILEAGE z� POINT POINT START FINISH NATURE OF BUSINESS MILL U P t £6 MILE v i pot FY MT Y Z 7 1 r1A0(1()Y1 Y T o to f t 71 n 4 U 1 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 Chapier 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all jusl credits end that no part of the same has been paid. Date OCT 0 6 2009 PRESCRIBED BY STATE BOARD Of ACCOUNTS GENERAL FORM NO 101 (19867 MILEAGE CLAIM TO (GOVERNMENTAL UNIT) V ON ACCOUNT OF APPROPRIATION No. FOR (OFFICE, BOARD, DEPAATM:EXT OR ENSLTIIJTION) SPEEDOMETER U FROM TO I EIEADING AUTO MTt E 20 POINT POINT STAR7 FINISH NATURE OF BUSINESS TRq FLED PER MILE o l'lt3 S LOA KNCNI I W\9�9 O L S F S T I e O O O O O O O CD 0 0 0 0 0 O O 0 0 CD 0 CD Q Ln GO O t!1 Lf\ n n n In Ln LIl n O O OLf" Ln O O O O O 11'� t!l L(1 p p e e p e o e e p a e Lfl U1 Lfl tSl LIl LS\ L41 Lf1 Lf1 CD O O` TOTALS ial highway map. -he amount claimed is legally due, after allowing a juS Credits .�.1,a LUVJ 1 1� pALSCHiBED BY STATE BOARD OF ACCODN75 GENFAU FORM NG. 101 (19BO MILEAGE CLAIM\ 1 so Y (GOVERNMENTAL nN1TI ON ACCOUNT OF APPROPRIATION NO. FOR IOFn BOARD, bEPARThWa OR 1NSUntrION) 5P%EDOMETER 2 DAT FROM TO I FIFADING AUTO MILEAGE V U POINT POINT START FINISH NAE OF BUSINESS TRAVELED a, f PER MILE TIAOt 1 b AN) UYN t l. 4 J c�AC Y) Nv n 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 185, Acts 1953, 1 hereby certily that the foregoing account is just and correct, that the amount claimed is legally due, after aliowing all just credit and that no part of the same has been paid. Date L Y r OCT O 6 1009 I <Y Ji PRE5CAI![4 BY STATE BOARD OF ACCOUNTS I� GEMEp ALiORM t /G. 101 (19861 MILEAGE CLAIM 0, TO (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR (OF, BOARD, DEFAATM]R Op INSTITUTION) SPEZDOMETFR FROM TO AUTO E DAT READING t 2� START FINISH NATURE OF BUSINESS POINT POINT TRAVELED PER MILE J Monm Li Z (A a IA Z '31 IV ZZ Ivvy1m G I ZZ I F a J ULU Z3 6 I L9 Z X) 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, f hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowing i st credit end that no part of the same has been paid. Date f OCT O 6 1009 I :.....o..... PRESCRIBED BY STATE BOARD OF ACCOUNTS GFXF.PAL FORT! NO. 101 11x867 MILEAGE CLAIM TO (GOVERNMENTAL UNL7E7 ON ACCOUNT OF APPROPRIATION NO, FOR (OF71GE, BOARD, OEPART4RH1 OR Ut0nLfI10N) FROM TO SPEEDOMeA AUTO DATE READING TE 2-D NATURE POINT POINT START FINISH NATURE OF BUSINESS MME E Eo r EA MILE t O O' a (7 l 2 AUTO LICENSE NO. TOTALS 70 SPEEDOMETER HEADING columns are to be used only when distance between points cannot be determined by fixed mileaqe 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 legally due, after allowing all just redits end that no part of the same has been paid. Date T. OCT Q 6 2009 PRESCRISED BY STATE BOARD Or ACCOUNtS GENERAL FORM NO. 101 119867 MILEAGE CLAIM ro 1GOVEBNMENTAL VN1'rt ON ACCOUNT OF APPROPRIATIDN NO- FOR (OMCE, BOARD, DEPAAMM OR 1KSrrr1rr10N) SPEEDOMETER AUTO LE E D' }Alz,'E FROM TO READING NATURE OF BUSINESS FILES D 2 8 .E POINT POINT START FINISH FT AVE t Ll Nc Wky) tV1 OY1 V� ^vt'10Y L1 r l 1 tite t GY�0�1 5 N1D 1 2 S OnC)Y1 r 2 �1nC]L'1 2 1 MUM ti rn 2e7 f2 AUTO LICENSE NO. TOTALS 2, 115 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, l hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allow g j St credi and that no part of the same has been paid. Date r; O CT 6 2009 PAFSCAIRED BY STATE BOARD OF ACCOUNTS GTRFRAL FORL NO. 03 uWq MILEAGE CLAIM (GOVERNMENTAL UNITS ON ACCOUNT OF APPROPRIATION NO. FOR (OFFICE, BOARD- DEPAATHFNr OR MSTTMION) SPEEDOMETER DATE_ FROM TO I READING NATURE OF BUSINESS M[T. O r POINT POINT START FINISH TRAVELED P MILE S 0 1 5. C5 05 5 '7 n© ti r tour -et� p Let e C V 5 Z8 M 01 ken S 2 O 5 AUTO LICENSE NO. TOTALS 2 (P 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 correcf, that the amount claimed is legally due, after afiowing all just credits and that no part of the same has been paid. Date AA)A 3�c g OC 0 6 2009 1 6, r: 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. 360484 Baldauf, Amy Terms 126 Lark Dr., Apt. D Date Due Carmel, IN 46032 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 9/18109 reimb. Food for site celebration 240.48 9130109 reimb. mileage 116 9129109 565.18 I� Total 805.66 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. 360484 Baldauf, Amy Allowed 20 126 Lark Dr., Apt. D Carmel, IN 46032 In Sum of$ 805.66 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept 1046 reimb. 4239040 240.48 1 hereby certify that the attached invoice(s), or 1046 reimb. 4343004 565.18 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 805.66 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund 1