HomeMy WebLinkAbout168552 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 362504 Page 1 of 1
ONE CIVIC SQUARE MICHAEL JACKSON
CARMEL, INDIANA 46032 5914 SANDALWOOD DRIVE CHECK AMOUNT: $67.89
CARMEL IN 46033 CHECK NUMBER: 168552
CHECK DATE: 2/4/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER A DESC
1125 4343000 67.89 TRAVEL FEES EXPENSE
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Indiana Green Expo
Mike
Mike Jackson
Carmel Clay Parks
Recreation- Admin.
Carmel, IN
Carmel o Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of
Receipt Vendor listed on receipt Fund Department Account Line Account Descri tion Amount Purpose of Expense
I�IZ'o� 0 0 III L 3.5r 7 o o�L e>Cl cin ins ��c�. �2� Gv a(k"
'7 I 0 �f o� 1 W °�O e/J -au /s (U 1 l J `f 3� 0 �X�cr�'/c -ILt oh �UV u�ki
All receipts should be attached in the same order as listed above.
TOTAL
Name (print) A
Check Address Sum w�o JAN 2 3 2009
payable to:
City, St, Zip 3 3
i�C/fce BY: I
Signature Date: 011
Approved by: Date: I
2-1
Revised 3 -2 -07 by Business Services
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1906)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD. DEPARTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER READING AUTO MILEAG
WLES
L �l� POINT POINT START FINISH NATURE OF BUSINESS 9pAVELED S a
PER MILE
Jr.n I h e e T T e C ✓M i e f /t er O O ,can ci. e^ e o U
`u 1 7, C o .A e n der «:_H ^c t c e '7100 a re e^ ex&e l C�
o a: fcn a—c c o c. 4 e• 7l 9 7 1! 5 q t t I l
v 1 e� f c M q. n oti. p 11 u 1 I 11 O lco
AUTO LICENSE NO. TOTALS �p Lr 3S ;?'0
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, ter all ing all st credits
and that no part of the same has been paid.
Date S a 1 I `i� 0 9
I
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.
Terms
Jackson, Michael
1 5914 Sandalwood Drive
Carmel, IN 46033
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s)) 32,69
1/14/09 reimb. Meals, parking for INLA conference 35.20
1/14/09 reimb. Mileage INLA conference
Total 67.89
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.
Jackson, Michael Allowed 20
5914 Sandalwood Drive
Carmel, IN 46033
In Sum of
67.89
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1125 reimb. 4343000 32.69 1 hereby certify that the attached invoice(s), or
1125 reimb. 4343000 35.20 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
2 -Feb 2009
Signature
67.89 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund