168682 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 357470 Page 1 of 1
ONE CIVIC SQUARE REBECCA SCHMIESING
CHECK AMOUNT: $93,48
CARMEL, INDIANA 46032 124 HILLCREST DRIVE
WESTFIELD IN 46074 CHECK NUMBER: 168682
CHECK DATE: 2/4 /2009
DEPARTMENT ACCO PO NUMBER INVO NUMBER AMOUNT DESCRIPTION
1125 4343000 93.48 TRAVEL FEES EXPENSE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1985)
MILEAGE CLAIM R� F3�LC �c�i +M i S iNG
17 Rks To
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSTITUTION)
DATE_ FROM TO READ NGE AUTO MILEAGE
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED 4
PER MILE
1 r Cn b to tre Q
a P r _u L r o
r k o b t� Lao C4 er
Lo f ►_7q r2rx,e O
AUTO LICENSE NO. TOTALS LP 65 'PD
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, after allowing all just credits
and that no part of the same has been paid.
Date
RECEIVED
JAN 2 3 2009
BY:
Carmel o Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of
Receipt Vendor listed on receipt Fund Department Account Line Account Description Amount Purpose of Expense
3, 09 t o WD r IN I l a5 `f35 70 e rrr,I nor chi nn /5.00 PQCk; (Green
09 Sun 67aala //25 4327 x+v ion 15 .00 Parkin CCv n
14 u J,_ ho ki lot 1 1 ,2 5 7ao4 etc -de r r)J i a as Lunc CC-i Kee o
/01 /Ja5 '43S70o4 r nai in iyuch on Lo o Co V Lun& (6r een
T
All receipts should be attached in the same order as listed above.
TOTAL I s
Name (print) Pi }0 CQ �rYl�'C51nG RECEIVED
Check Address �a` t ;kyen Dr. JAN 2 3 2009
payable to:
City, St, Zip ��21 'D BY
Signature Date: j D
Approved by: i� Date: —2-3 n
Revised 3 -2 -07 by Business Services
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.
357470 Schmiesing, Rebecca Terms
124 Hillcrest Drive Date Due
Westfield, IN 46074
Invoice voice Description
Date jjNjumber (or note attached invoice(s) or bill(s)) Amount
1/14/09 eimb. Mileage INLA conference 35.20
1/14/09 eimb. Meals, Parking INLA conference 58'28
Total 93.48
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.
357470 Schmiesing, Rebecca Allowed 20
124 Hillcrest Drive
Westfield, IN 46074
In Sum of
93.48
i�
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 reimb. 4343000 35.20 1 hereby certify that the attached invoice(s), or
1125 reimb. 4343000 58.28 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
P
2 -Feb 2009
Signature
93.48 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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