207878 04/10/2012 CITY OF CARMEL, INDIANA VENDOR: 365946 Page 1 of 1
ONE CIVIC SQUARE NANCY GOINS
�?a CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $141.57
CHECK NUMBER: 207878
CHECK DATE: 4/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 141.57 TRAVEL FEES EXPENSE
Carmel Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
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All receipts should be attached in the same order as listed above. 6�
No sales tax will be reimbursed. TOTAL: 3
Employeen Name (print)
I Ma P 2 8 1012
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Address V S U V LA.)/
Check ty, p nu _S-- (l! "C l.C��
payable to: Ci St, Zi r By
Signature: II Approved by:
Date: 2-i. Z Date:
Revised 3 -2 -07 by Business Services;
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Nancu Goins
Extended School Enrichment for
Carmel Clay Parks and Recreation
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PRESCRIBED 87 SrA7L BOARD Or ACCOUNTS
GENERAL FORM 140. 101 11905)
MILEAGE CLAIM
0 1 V1tiQ,..� �1Ci V� Pu Ck s a ✓�C,) C J l 0 k TO
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VCRMILWAl UN
C, tn ON ACCOUNT OF APPROPRIATION NO. FOR
tOMCZ, BOARD, DEPARnR7rr OR INSTCTUM N)
FROM TO SPEEDOMETER AUTO MILEAGE
q �DATE READING MILES
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED -7
PER l At[ T
l
AUTO LICENSE NO. TOTALS P Z I
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 gaily du after aliow all j t credits
and that no art A the same has been paid.
Date
(Id I-
I MAR 2 8 1011
1 r}
PRESCRIBED BY STATE BOARD Of ACCOUNTS GENERAL FORL IIC, 101 0%fi)
MILEAGE CLAIM ,n
f 1 anc� s
TO
ckf IY�Q 1
S
{O nIN1a T N M UNIT) CC
ON ACCOUNT OF APPROPRIATION NO. FOR ��er!!
(OF. BOARD, DVMT]�]fT OR INSTITUTION)
SPEEDOMETER
2.6 DATE FROM TO READING A UTO MILEAGE
c
NATURE OF BUSINESS .1 --y�
pOINT POINT START FINISH 7'AAVELED
PER MILE
LhAC
13 1
1
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l
r-3
30
aL
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 1 I hereby certify that the Ior_egpip_g account is just and correct, that the amount claimed is gall due, after aliow g all ust credits
end that no art o the same has been paid.
Date �7i`
MAR 1 8 2012
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.
365946 Goins, Nancy Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
3/21/12 Reimb Mileage 1/3 3/13/12 107.57
3/21/12 Reimb Expenses for Afterschool IN Conferrence 34.00
Total 141.57
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.
365946. Goins, Nancy Allowed 20
In Sum of
141.57
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -1 Reimb 4343000 107.57 1 hereby certify that the attached invoice(s), or
1081 -99 Reimb 4343000 34.00 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
5 -Apr 2012
Signature
141.57 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund