211859 08/14/2012 ��. CITY OF CARMEL, INDIANA VENDOR: 366457 Page 1 of 1
ONE CIVIC SQUARE M.CAROLINE MCCAULAY
01 � CHECK AMOUNT: $44.41
CARMEL, INDIANA 46032 CIO ESE
CHECK NUMBER: 211859
CHECK DATE: 8/1412012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 REIMB 44 .41 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
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $ On I +$-"�-f�
Employeen Name(print) + Cwaj kT'L C(W �M AUG 0 7 2012
t,
Address S�� ►v1VVl, ;Yd C'V-
Check
payable to: City, St, Zip 'IY��
Signature: �' Q'L(� CV�1 Approved by:
Date: -7 Z�I �� _ Date: �� V
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 140.JOA(1986)
MILEAGE CLAIM
'0—
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO.- FOR
(OFFICE,BOARD,DEPARTMENT OR INSTITUTION)
SPEEIZOMETER
DATE FROM TO READING + AUTO MILEAGE-- -I - MILES @
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
J- J
-7
V V I L" 141 q, I
-71
<Yy
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
end that no part of the same has been paid.
Date
.17 n
q 3q �� AUG 0 7 2012
LJIL-
ti
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.
McCaulay, M. Caroline Terms
5118 Hummingbird Cri
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
7/29/12 Reimb Parking $ 6.00
7/18/12 Reimb Mileage 6/13 -7/18/12 $ 38.41
Total $ 44.41
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.
McCaulay, M. Caroline Allowed 20
5118 Hummingbird� C'r
Carmel, IN 46033
In Sum of$
$ 44.41
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-1 Reimb 4343000 $ 6.00 1 hereby certify that the attached invoice(s), or
1082-1 Reimb 4343000 $ 38.41 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
$ 44.41 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund