HomeMy WebLinkAbout178247 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 355133 Page 1 of 1
ONE CIVIC SQUARE AUDREY B KOSTRZEWA
CARMEL, INDIANA 46032 2592 TURNING LEAF LANE CHECK AMOUNT: $141.67
CARMEL IN 46032 CHECK NUMBER: 178247
CHECK DATE: 10/14/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4341991 57.50 MARKETING PROMOTION
1125 4342100 16.52 POSTAGE
1125 4343004 67.65 TRAVEL PER DIEMS
Carmel Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
30- Apr -09 Carmel Post Office 1125 4342100 Postage 10.98 Certified mail
24- Jul -09 Carmel Post Office 1125 4342100 Postage 5.54 Certified mail
V/ Classified ad
23- Sep -09 Indianaoplis Newspapers 1047 4341991 Marketing /Promotions 57.50 (required immediate payment)
2009 Audrey Kostrzewa 1125 4343000 Travel fees Expenses 67.65 Mileage reimbursement
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $141.67
Employee Name (print) Audrey Kostrzewa
Address 2592 Turning Leaf Lane
Check
payable to: City, St, Zip Carmel 4032
Signature: e Approved by:
Date: a l Date:
Business Services Division, Revised 7 -7 -08
00 1 3 9 7 31
FILE: Shared\Administrative \Forms \Staff Forms \Employee Exp Reimb Request
S E P 3 0 2009
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SEP -29 -2009 07:55A FROM:THE INDIANAPOLIS STA 3174447373 TO:9571413E P.1/1
TI S42-C.<--a- GaA s Y13
INDIANAPOLIS NEWSPAPERS INC. Receipt No;
PAYMENT RECEIPT AD COPY Ad Number; 5542863 System Acct; 984295
Customer: CARMEL CLAY PARKS RECREATION Phone: 3175734020 Account No:
1235 CENTRAL PARK DR E
CARMEL, IN 46032
Class: 251; GARAGE SALES NORTH
Start Date: 10/08/2009 End Date: 10/10/2009 Times Ordered: 7 Net Price: $57.50
Amount Paid: 0 Payment Method: CC
Check No: Credit Card:
Dates: 10/08/ 200910 /08/200910/08/ 200910 /09/200910/09/200910 /10/2009 10/10/2009
Date Printed: 09/23/2009
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PRESCRIBED BY STATE BOAR of ACCOUNTS GENERAL FORM NO. 101 (1925)
MILEAGE CLAIM
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(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE. BOARD, DEPAP.TMENT OR INSTITUTION)
FROM TO 'SPEEDOMETER AUTO MILEAgE
DATE READING 4 S
NATURE OF BUSINESS MILES
POINT POINT START FINIS H TRAVELED PER MILE
4-7 1
AUTO LICENSE NO. TOTALS &2
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, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after aliowi Ag all just credits
and that no part of 0e same/has been paid.
Date 2/� Y /z�
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ODOMETER MILEAGE
DATE DESTINATION /BUSINESS PURPOSE BEGIN END BUSINESS PERSONAL
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DATE DESTIN NESS PURPOSE ODOMETER MILEAGE
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ACCOUNTS PAYABLE VOUCHER
f 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.
Kostrzewa, Audrey Terms
CCPR Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
09/30/09 Reimb. Certified mail $16.52
09/30/09 Reimb. Indianapolis Newspapers classified ad $57.50
$67.65
09/30/09 Reimb. Mileage 1/1- 9/30/09
Total 141.67
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
Voucher No. Warrant No.
Kostrzewa, Audrey Allowed 20
CCPR
Carmel, IN 46032
In Sum of
141.67
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund 104 Program Fund
PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept
1125 Ck Request 4342100 16.52 1 hereby certify that the attached invoice(s), or
1047 Ck Request 4341991 57.50 bill(s) is (are) true and correct and that the
1125 Ck Request 4343004 67.65 materials or services itemized thereon for
which charge is made were ordered and
received except
7 -Oct 2009
Signature
141.67 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund