169984 03/18/2009 �.f CITY OF CARMEL, INDIANA VENDOR: 355133 Page 1 of 1
ONE CIVIC SQUARE AUDREY B KOSTRZEWA CHECK AMOUNT: $42.92
CARMEL, INDIANA 46032 2592 TURNING LEAF LANE
a o CARMEL IN 46032 CHECK NUMBER: 169984
CHECK DATE: 3/18/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4342100 23.39 POSTAGE
1125 4343004 19.53 TRAVEL PER DIEMS
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO (/1 CAS J r Z�=L�Jrt
(GCVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE. BOARD. DEPARTMENT OR INSTITUTION)
FROM TO SPEEDOMETER AUTO MILEAGE
DATE READING MILES
POINT j POINT START FINISH NATURE OF BUSINESS C
TRAVELED PER g E
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. fff
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 allowing all just credits
and that no part of the same has bee paid.
Date 3 J Q c -p
MAR 0 4 2009
BY:
i
o?QO�f =FEBRUARY MILEAGE RECORD
ODOMETER MILEAGE
i DATE D ON /BUSINESS PURPOSE BEGIN END BUSINESS PERSONA
-2 /I?C 5
3.6
Yl d-
1
j a 0 10 s
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AFRI10
sue TOTAL
F MAK 0 4 2009
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�Y:
o
R
MWd
•s
C armel lay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
�laCe /D
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All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: T 7-3
Employeen Name (print) uD/Z!c y s TYL -Z��,�
l MAR 0 4 2009
Address o?5 9 IUIe1V jA1 �L:/� i
Check
payable to: City, St, Zip �4KmL (40 D 3a BY:
Signature Approved by:
Date: 3 /13 o Date: SI- 2
Revised 3 -2 -07 by Business Services;
Shared /Forms and Templates /Business Service Forms /Employee Exp Reimb Request 2007 -3
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.
355133 Kostrzewa, Audrey Terms
2592 Turning Leaf Lane Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
03/03/09 reimb Mileage Jan, Feb'09 $19.53
03/03/09 reimb Postage $23.39
Total 42.92
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
f
Voucher No. Warrant No.
355133 Kostrzewa, Audrey Allowed 20
2592 Turning Leaf Lane
Carmel, IN 46032
In Sum of
42.92
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1125 reimb 4343004 19.53 1 hereby certify that the attached invoice(s), or
1125 reimb 4342100 23.39 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
12 -Mar 2009
4,
Signature
42.92 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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