HomeMy WebLinkAbout177328 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 363113 Page 1 of 7
ONE CIVIC SQUARE AMY MUNCY CHECK AMOUNT: $168.72
4° CARMEL, INDIANA 46032 2456 FOX HARBOUR 5 DRIVE
INDIANAPOLIS IN 46227 CHECK NUMBER: 177328
CHECK DATE: 911512009
DEPARTMENT T ACCOUNT PO NU MBER INVOICE NUMBER AMOUN DESCRIPTION
1046 4239037 REIMB 17.74 CLUB ACTIVITY SUPPLIE
1046 4343004 REIMB 150.98 TRAVEL PER DIEMS
Carmel o Clay
Parrs &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
'Lt GVeam f fo(c rg f (l ej
i
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL.:
Employee Name (print) Am WA AUG 1 9 2009
Address I
Check
payable to: city, St, Zip I �L (A �l S I
Signature: O AM Approved by:
Date: Date:
Business Services Division, Revised 7 -7 -08
FILE: Shared \Administrative\Forms\Staff Forms\Empioyee Exp Reimb Request
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORE Nc. 10] (1985)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNLIT
ON ACCOUNT OF APPROPRIATION NO. FOR
I6Fi10E, BOARD, DFPAXTWEXF OR INSER[rFION)
SPEEDOMETER
DgnTUg FROM TO I HEADING MILES MILE AGE
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
Tj2 tt
t 1 111 i n a
In 1
L C
6 0
n 'n 2S
Cj if C1rGt[c 1�r� 1'
c r Ls
AWA 11) mbri a ir: t 1 F
IkAfA 1 al i1v L, p 1 -IA V 1,
l a --e-
AA AQ 11 F s_�
Ai A WL 6tAwi! I`I 1 0
Al A l t S i e 0 1
`r" t Ls nor arsi7 fOh
e e to Sr.
Al A
ON V1 a1' Ol 4G 15 1 r
r1 r/ c� r�� 1
tn u a
E V J "'r u� -tit vn i s r
l Yv) I- fl R 3
r C4r r rrCJf Irs r'' 3`
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 1353, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, er aliowmg all just credits
and that no part of the same has been paid.
Date
AUG 2 8 2009
1
49
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. 101 (1986)
MILEAGE CLAIM
TO
OOVERNI(ENTAL UN1n
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFYiCE, BOARD, DEP.AATMpff OR INSTMyrJON)
FROM TO SPEEDOMETER AUTO N.ILEAGE
Z
DATE NEARING
8 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PfR MILE
AA `7 1 i I
Ill 0 �A Q 1^ 0 r f 01 (,.L. S L
I u( a 3
nl Sid .11t' y
2
raltr r 42 4
c 3.
I
AUTO LICENSE NO. TOTALS by 5— 30
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 dua, ter allowing all just credits
and that no part of the Same has been paid.
Date
AU 2 8 2009 I I
1
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.
363113 Muncy, Amy Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
8/17109 Reimb. Kroger, club supplies 8/14/09 17.74
8128/09 Reimb. Weage 8/4 8121/09 150.98
Total 168.72
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,
363113 Muncy, Amy Allowed 20
In Sum of
168.72
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 Reimb. 4239037 17.74 1 hereby certify that the attached invoice(s), or
1046 Reimb. 4343004. 150.98- 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
10 -Sep 2009
Signature
168.72 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund