221950 07/17/2013 CITY OF CARMEL, INDIANA VENDOR: 363065 Page 1 of 1
ONE CIVIC SQUARE JAMES DOWELL CHECK AMOUNT: $385.43
CARMEL, INDIANA 46032 C/O PARKS-ESE
CHECK NUMBER: 221950
CHECK DATE: 7/1712013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4239039 REIMB 77 . 28 GENERAL PROGRAM SUPPL
1082 4343000 REIMB 308 . 15 TRAVEL FEES & EXPENSE
Carmel Clay
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # JLine# Budget Description Amount Purpose of Expense
I l , 3"7 `J� �� es
)11/ i3 «>ti�e e �� 08a 3 , es
All receipts should be attached in the same order as listed above. —7
No sales tax will be reimbursed. TOTAL: $ 7 /,
Employeen Name(print)
Address �-
Check
payable to: City, St, Zip- _
Signature: Approved by:
Date: Date:
Revised 3-2-07 by Business Services;
Shared/Forms and Templates/Business Service Forms/Employee Exp Reimb Request 2007-3
x
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NC.101 09067
p MILEAGE CLAIM U
CCU `l r To ML
(GOVERNMENTAL UNIT) '— ON ACCOUNT OF APPROPRIATION NO. FOR
- (oF71cE,BOARD.DErARrwxr OR tnsrmruox)
FROM TO SPEEDOMETER
r AUTO 11ILEAG
DATE READING + NATURE OF BUSINESS TRAVELED MIL t r
Zd POINT POINT START FINISH PER MILE
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AUTO LICENSE NO_ TOTALS I (-I V a //
+ 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
end that no pari of the same has been paid
Date
q3q3-ioo�
PRTSCRIBED BY STATE BOARD Or ACCOUNTS T GENERAL fORL NG IQI(INS)
MILEAGE CLAIM
\
"'���JJJ G CY) w�
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
(Off iC£,BOARD,DFPARTM'FM OR INSLRUIlox)
- SPEEDOMETER AUTO MIL�AG�
DATE FROM TO I READING + NATURE OF BUSINESS ES a •� b C
Zo_ POINT POINT START FINISH TRAVELED PER MILE
I
-- L` ------- g. _
!o l q joq c,
1 .
6 ! U � L ,j 7.
L / 1 a
C- V 'd- 9 —
C UJ C o f
U G C, +-0 CT
I
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 )ust credits
end that no part of the same has been paid.
Date
i
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.
363065 Dowell, James Terms
9353 Barcroft Dr, Apt A
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
6/11/13 Reimb. Supplies Ace Hardware, Home Depot $ 77.28
6/21/13 Reimb. Mileage 5/6 - 6/21/13 $ 308.15
Total $ 385.43
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.
363065 Dowell, James Allowed 20
9353 Barcroft Dr, Apt A
Indianapolis, IN 46240
In Sum of$
$ 385.43
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
Dept#
INVOICE NO. CCT#/TITL AMOUNT
1082-13 Reimb. 4239039 $ 77.28 1 hereby certify that the attached invoice(s), or
1082-13 Reimb. 4343000 $ 308.15 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-Jul 2013
Signature
$ 385.43 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund