HomeMy WebLinkAbout206158 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
ONE CIVIC SQUARE TIFFANY BUCKINGHAM
0 CHECK AMOUNT: $163.03
CARMEL, INDIANA 46032 5130 PRIMROSE AVE
INDIANAPOLIS IN 46205 CHECK NUMBER: 206158
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 37.88 GENERAL PROGRAM SUPPL
1081 4343000 REIMB 125.15 TRAVEL FEES EXPENSE
PAPSCRIB[D BY STATE BOARD OF ACCOUNTS
GENERAL FOAM NO. 10) 11906)
MILEAGE CLAIM
01 Pe C- (GOVERNMENTAL
ON ACCOUNT OF APPROPRIATION NO. FOR
(Or7CE, BOARD, DEPARTMENT Oe 1NSTrrUriO8)
SPEEDOMETER AUTO )ZLEAGE
DATE FROM TO I HEADING NATURE OF BUSINESS MILES a 57- r
IF 2-� -_--L- POINT POINT START FINISH TRAVELED PER MILE
C-
2 2rn C
A C
0 P y C C
c. i
AUTO LICENSE NO. TOTALS 2 �55b I �J
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, afte allowing all just credits
and that no part of the same has been paid.
Date
Ca
IIH
3 0 2 ZOi Z UV
yr I
BY:
Carmel o Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description i;/95 Amount Purpose of Expense
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
Employeen Name (print) F EB 2 2012
Address At 5 e
Check
payable to: City, St, Zip 1� oltanc 9w 1 1
Signature: Approved by: i
Date: Date: O I "J 1 -2—
Business Services Division, Revised 3 -2 -07
FILE: Shared\Administrative \Forms \Staff Forms \Employee Exp Reimb Request
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.
358408 Buckingham, Tiffany Terms
5130 Primrose Ave
Indianapolis, IN 46205
Invoice j;;Number voice Description
Date (or note attached invoice(s) or bill(s)) PO Amount
1/30/12 eimb. Mileage 11/28/11 1/30/12 125.15
1/31/12 Reimb. Supplies 37.88
Total 163.03
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
358408 Buckingham, Tiffany Allowed 20
5130 Primrose Ave
Indianapolis, IN 46205
In Sum of
163.03
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -2 Reimb. 4343000 125.15 1 hereby certify that the attached invoice(s), or
1081 -2 Reimb. 4239039 37.88 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
9 -Feb 2012
Signature
163.03 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund