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Home My WebLink About169146 02/17/2009 CITY OF CARMEL, INDIANA VENDOR: 362100 Page 1 of 1 1 0� ONE CIVIC SQUARE PAULA SCHLEMMER CARMEL, INDIANA 46032 9455 CANOPY LANE CHECK AMOUNT: $25.53 FISHERS IN 46038 CHECK NUMBER: 169146 CHECK DATE: 2/17/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4342100 7.05 POSTAGE 1125 4343004 18.48 TRAVEL PER DIEMS p Carmel ay Parks &Recreation Employee Expense Reimbursement Request Date of Fund Account Account Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense 12-19-09 FMS+ O cci c co-r rn -e- 1 2 I DO C- Q l 1) j TEri t" All receipts should be attached in the same order as listed above. -7 t� No sales tax will be reimbursed. TOTAL: O �J Employee Name (print �ln Address FFi� 2009 I Check payable to: City, St, Zip Signature: Gt. Approved by. Date: ,J�' Date: U D Business Services Division, Revised 7 -7 -08 FILE: Shared\Administrative \Forms \Staff Forms \Employee Exp Reimb Request PRESCRIBED BY STATE BOARD OF ACCOUNTS GENF.RAL FORM NO. 101 (1986) MILEAGE CLAIM TO P"C"t- L-n' oA Ll�- CArZ%AeL--CL-Ay PA(-->1,/-S -SC�L m-- (GOVERNMENTAL UNIT,' ON ACCOUNT OF APPROPRIATION No. FOR (OFFICE, BOARD, DEPARTMENT OR INSTITUTION) DATE FROM TO j SPEEDOMETER READING AUTO MILEAGE NATURE OF BUSINESS MILES POINT POINT START FINISH TRAVELED PER MILE I M ern C- 15 A, LL IV Vntj('��PS v C- 0, To, C L-tFRK /T 0 Al) D L- TVIEn i ILT) a. 1 /V0. T Mon on CeAllteV i (I ill MML Iq A,D.'M P.n. rc-Wrl�:) PACrKA&� ffJ 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. 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 allowing all just credits -and that no part of the same has been paid. Date RIECF1 VED 4) e) l 0 1 FEB 0 2 2009 BY: PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO, 101 (15E r!) MILEAGE CLAIM Pp'uLnx j\!\ E CL TO y tGOVERNMENTAL UNIT' ON ACCOUNT OF APPROPRIATION NO. FOR (OFFICE, BOARD,. DEPARTMENT OR INSTITUTION) SPEEDOMETER DATE FROM TO READING AUTO MILEAGE MILES 2P 019 POINT POINT START FINISH MATURE OF BUSINESS TRAVELED PER MILE A.0. CIT ly RETUP-0 LLl- VER d0 S Aker A 0. M. RE 7?Jl-?-I) A MMI AA AA EA '74A F—F—P NO r1C-k1JP IAIVIDICES MPIL I Ian a0 A .0, 11 mc- f-3� f 1 '1t'141 l A r) L 7 Ao r h=�4 I M6)r!S A-11 A (h+( -Aa the ri Vz'- Lr V tk) 11 ALO 7) f 4 7 A 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. 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 isle ally due, after allowing all just credits end that no part of the same has been paid. Date oy�' FEB 0 2009 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. 362100 Schlemmer, Paula Terms 9455 Canopy Lane Fishers, IN 46038 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 1/30/09 Reimb Postage 7.05 1/30/09 Reimb Mileage 12/4/08 12/19/08 4.45 1/30/09 Reimb Mileage 1/5/09- 1/30/09 14.03 Total 25.53 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 1 20 Clerk- Treasurer Voucher No. Warrant No. 362100 Schlemmer, Paula Allowed 20 9455 Canopy Lane Fishers, IN 46038 In Sum of$ 25.53 ON ACCOUNT OF APPROPRIATION FOR 101 -General Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1125 Reimb 4342100 7.05 1 hereby certify that the attached invoice(s), or 1125 Reimb 4343004 4.45 bill(s) is (are) true and correct and that the 1125 Reimb 4343004 14.03 materials or services itemized thereon for which charge is made were ordered and received except 13 -Feb 2009 Signature 25.53 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund