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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 =_r _alb h rJ I 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