222013 07/17/2003 CITY OF CARMEL, INDIANA VENDOR: 366239 Page 1 of 1
0 ONE CIVIC SQUARE MONICA HADDOCK CHECK AMOUNT: $133.56
CARMEL, INDIANA 46032 C/O ESE
CHECK NUMBER: 222013
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CHECK DATE: 7/17/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4239039 REIMB 69 . 71 GENERAL PROGRAM SUPPL
1082 4343000 REIMB 63 . 85 TRAVEL FEES & EXPENSE
=BY:—
Carmel � ���y
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # ;Line# Budget Description Amount Purpose of Expense
U5, h al 4 g6
j
All receipts should be attached in the same order as listed above. $ ug --11
No sales tax will be reimbursed. TOTAL:
Employeen Name(print) M-)n ( nA �nd ( ch
Address��'�� -
Check
payable to: City, St, zip V.-(11
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Signature: Effimd,(/-A ( Q�(�� Approved by:
Date: � 0 �,� Iabl Date: Z .�
Revised 3-2-07 by Business Services;
Shared/Forms and Templates/Business Service Forms/Employee Exp Reimb Request 2007-3
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+ SP> bdSTffi2 R8AWG oolamas are to be used only when distance bstwmn palate cannot be detensfned by fixed mtlea"or OSicldil highway map.
Pursuant to tho providaas and poaalties of Chapter 159,Acts 199,I hereby aertdy that the foregoing account is just and correct.that the amnnnt claimed is 199auy due,after allov"I an just credits
end that no part of the*am has been Daid.
Bate
log
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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.
366239 Haddock, Monica Terms
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO # Amount
6/25/13 Reimb Michael's supplies $ 69.71
6/28/13 Reimb Mileage 6/4 - 6/28/13 $ 63.85
Mileage 5/6-5/31/13
Total $ 133.56
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.
366239 Haddock, Monica Allowed 20
I
In Sum of$
i
$ 133.56 _
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1082-4 Reimb 4239039 $ 69.71 1 hereby certify that the attached invoice(s), or
1082-4 Reimb 4343000 $ 63.85 hill(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
$ 133.56 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund