HomeMy WebLinkAbout220098 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA CANADA
e CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE CHECK AMOUNT: $223.75
NOBLESVILLE IN 46060
CHECK NUMBER: 220098
CHECK DATE: 5121/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 95 . 00 GENERAL PROGRAM SUPPL
1081 4343000 128 . 75 TRAVEL FEES & EXPENSE
PRESCRIBED BT STATE BOARD OF ACCOU/=rH
GENERAL FORM NO.=01 11706)
MILEAGE CLAIM
TO
(GOVERNMENTAL UNI'n
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF)7C?,BOARD,DEPAATMr)fF OR INSrrnmom)
SPEEDOMETER �II.g
D FROM TO READING +
NATURE OF BUSINESS AUTO ES
POINT POINT START FINISH TRAVELED
PER MILE
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AUTO LICENSE NO. TOTALS
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing account is just and correct,that the amount claimed is legally due,after aliowing all just credits
end Ihet,np part of the s e has been paid.
Date (mil{ I( o�lt/LU
I
� I q I�
J
C C �T��
MAY 0 6 2013
PRESCRIBED BY sTATr BOARD OF ACCOUNTS GENERAL FORM 11C.IQI 11996)
MILEAGE CLAIM
(GOVERNMENTAL UNM
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF.1CF,BOARD,DEPARTMENT OR 1NST nr11ON)
SPEEDOMETER
DATE FROM TO READING + AUTO MILEAGE
BUSINESS NATURE OF BUSIS MILES C$ c E� r
POINT POINT START FINISH TRAVELED PER MI[E
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Z T� tz 7
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monZYN
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AUTO LICENSE NO. TOTALS
U0 CJ
C
+ 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 of
7 MAc F
Y 0 6 2013
rRUSCSIAED DT STATE BOARD OF ACCOUNTS GEMIAL FORM ur: M IM11
MILEAGE CLAIM
TO.._......._..__._.—._—
ON ACCOUNT OF APPROPRIATION NO. FOR
tOINCE•BOA RD W&RTWZ"On 1"Sr=1OW7
---—------
FROM To SprEDONIXTER AUTO MILEAGE
DATTY HEADING NATURE OF BUSINESS MIM a
POINT POINT START FINISH TRAVELF0 PER MILE
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3"
r) Yin
AMIT- L f1 41� 1. Q
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fv\.e Ifl) L
All-
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11
AUTO LICENSE NO. TOTALS 01A
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or Official highway imap.
Pursuant to the provisions and penalties of Chapter 155,Acts 4953,1 hereby CeTtifY that Iiie foregoing account is just and correct.that the amount claimed is legally due,aher aliniving all Last credit-
end that nit of the same has been paid.
Date
MAY 0 6 2013
BY:
Qdoba Mexican Grill
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2328 E, 1.16th Street
Carmel IN 46032
317-815-932C
TINT 1 :2:36
Host: Cash 1 05/02/2013
IN1236 5,54 01
10236
-i AC0 BAR 10 CHK 90,00
00
CAT BROWNIES (5 @0.50) 2'SO
(:A-i COOKIE:S (5 00,50) :2„50
Subtotal 9'5 MC
-fax Exempt 40119683083 0„00
I ax O MC
PICK-UP Total 95.,00
`
Cash 100.00
Change 3,O0
;f --- Check Closed.,---
aFme— 0-Clay
Parks&Recreats.on
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
5 a 13 J ; 1 OSI-'
e V. k:r
fNo ll receipts should be attached in the same order as listed above.
sales tax will be reimbursed. TOTAL: $ 5 '��
.�.=.J201�
Employeen Name(print) C��na MAY ® 7
Address
Check
L
payable to: City, St, Zip 1c)b o y Il P �►ti 1 Llbz-p Signature: C A-A Approved by:
Date: ( o Date:
Revised 3-2-07 by Business Services;
Shared/Forms and Templates/Business Service Forms/Employee Exp Reimb Request 2007-3
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized amustshoow, kind f service,
, price performed, dates service rendered, by
whom, rates per day, number of hours, r e per
Payee Purchase Order No.
Terms
360144 Canada, Cyndi
11508 Lucky Dan Dr
Noblesville, IN 46060
Invoice Invoice Description PO# Amount
Date Number (or note attached invoice(s) or bill(s)) $ 128.75
4/26/13 Reimb Mileage 1/2 - 4/26/13 $ 95.00
5/2/13 Reimb Qdoba Staff Appreciation event
Total $ 223.75
I 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.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of$
$ 223.75
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-5 Reimb 4343000 $ 128.75 1 hereby certify that the attached invoice(s), or
1081-5 Reimb 4239039 $ 95.00 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
16-May 2013
Signature
$ 223.75 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund