168387 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 357435 Page 1 of 1
ONE CIVIC.SQUARE ANDREW BURNETT
CARMEL, ODIANA 46032 9215 N. PARK AVENUE CHECK AMOUNT: $55.65
INDIANAPOLIS IN 46240
CHECK NUMBER: 168387
CHECK DATE: 2/4/2009
DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOUNT D ESCRIPTION
1125 4343000 REIMB 55.65 TRAVEL FEES EXPENSE
I
I
Indfana Green Expo
Andrew
Andrew Burnett
Carmel Clay Parks
Recreation- Admin.
Carmel, IN
PRESCRIBED By STATE BOARD OF ACCOUNTS GENEAAL FORM NO. 141 (1986)
MILEAGE CLAIM
To
(l30Y£PNMSNTAL UN31T
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTETUTION)
DATE FROM TO
SPE AUTO MILEAGE
2d NATURE OF BUSINESS MILES
POINT POINT START FINISH TRAVELED PER MILE
0 S
Of fd Or
.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. J
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 ali g all just credits
and that no part f the same has been paid.
Date
RECEIVED 3V\
JAN 2 3 2009
BY:
Carmel 0 0ay
Parks &Recreato®h
Employee Expense Reimbursement Request
Date of
Receipt Vendor listed on receip Fund Department Account Line Account Descrip Amount Purpose of Expense
I/z VorI d kA1G1) Pis YUl e lal 1 1 2 v e frwli, 1 o
Jas 4 lot 11 2T W3S7aw-I exfie�
1 113 1 q'ij 1 112.- L/ 35
All receipts should be attached in the same order as. listed above.
TOTAL
Name (print) ����IVED
Check Address jP JAN 2 3 2009
payable to: -n (P(5 -T f 6 W
City, St, Zip I BY:
Signature Date:
l
na :OV
Approved by: Date:
Revised 3 -2 -07 by Business services
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.
Burnett, Andrew Terms
9215 Park Avenue Date Due
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)) Amount
1114109 reimb. Mileage INLA conference 17.60
1114109 reimb. Meals, Parking INLA conference 38.05
Total 55.65
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
1 20
Clerk- Treasurer
i
Voucher No. Warrant No.
Burnett, Andrew Allowed 20
9215 Park Avenue
Indianapolis, IN 46240
In Sum of
55.65
st
ON ACCOUNT OF APPROPRIATION FOR
101 General
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 reimb. 4343000 17.60 1 hereby certify that the attached invoice(s), or
1125 reimb. 4343000 38.05 bili(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
2 -Feb 2009
Signature
55.65 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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