211634 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 365669 Page 1 of 1
ONE CIVIC SQUARE LAUREN BANGS
9�•?O
CARMEL, INDIANA 46032 C/O PARKS DEPARTMENT CHECK AMOUNT: $181.72
CHECK NUMBER: 211634
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 181 . 72 TRAVEL FEES & EXPENSE
S
Carmel ® Clay
9
Parks&Recreation
f
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
�2q3zoq S . G . 00
1 t
�- �v)C-K can c;� , t c G i� a-� 3�{3�°`� , 00
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $ 1
y
Employeen Name(print) La u r Can I5cky, `S
Address 1 010
Check 1 /
payable to: City, St, Zip (�(`�( L, , `C W 0 �2
Signature: Approved by:
Date: y" i\% U I Date:
Revised 3-2-07 by Business Services;
Shared/Forms and Templates/Business Service Forms/Employee Exp Reimb Request 2007-3
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110.101(1985)
MILEAGE CLAIM
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO, FOR
(OHICE,BOARD,DEPARTMENT OR INSTITUTION)
DATE R
FROM TO SPEEEAD ING DOMETER AUTO MILEAGE
2Q I +
POINT POINT START FINISH MATURE OF BUSINESS MILES
TRAVELED
Morlbir\ _Qg_4nt 11 ILI
1
C CA It K
-4- Ar 11 9,
a
J r K
eJ HOC I/ r1r H^Ag�n PAAAer
11 4-4
f-C r Ak�
r n n t? Le !.CA e 4.1
r
ounc n.--vd V11 C 11)1 a 114. QZ
r r- M�t'j 11 -
rqc'K'5�1 r__A0Tn_rN (-_vA'AeA_ 1 4-W
0 "4 si ('4'_-&k_CT5r-A PA 0 VN.VI n (�cg'n�t C r —
J 1
0 1 - �-r-e 0 f)Y-)6 r Pec&ALI: e- I I
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PAQ On in f KA 3r eel 1 9 1114. 4 1
r rr "C't r 11 Ll -21 C
i F
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.
M-a3t v
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 aliowing all'just credits
and that no part of the same has been paid.
Date
+q
AUG 0 7 2012
BY:
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.
365669 Bangs, Lauren Terms
14010 Brookstone Dr.
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
8/1/12 Reimb Parking $ 13.00
8/2/12 Reimb Mileage 5/29 - 8/2/12 $ 168.72
Total $ 181.72
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.
365669 Bangs, Lauren Allowed 20
14010 Brookstone Dr.
Carmel, IN 46032
In Sum of$
$ 181.72
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. 4,CCT#/TITLE AMOUNT Board Members
Dept#
1082-1 Reimb 4343000 $ 13.00 1 hereby certify that the attached invoice(s), or
1082-1 Reimb 4343000 $ 168.72 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
9-Aug 2012
Signature
$ 181.72 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund