226649 12/03/2013 CITY OF CARMEL, INDIANA VENDOR: 363065 Page 1 of 1
ONE CIVIC SQUARE JAMES DOWELL CHECK AMOUNT: $386.05
CARMEL, INDIANA 46032 C/O PARKS-ESE
CHECK NUMBER: 226649
CHECK DATE: 12/3/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 56 . 10 GENERAL PROGRAM SUPPL
1081 4343000 REIMB 329 . 95 TRAVEL FEES & EXPENSE
Carmel * Clay
Parks&Recreate®n
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # ,Line# Budget Description Amount Purpose of Expense
01-b 113 4,Me, e o� lost - = ` L-3 03 P1,0 rom -Z-3 , ICI ✓ S 0 e5
J O X51 - 5 -L/ ;L3 03 Pro Pat" 3 a C, es
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: 7s 5Z I D i
e—I —
Employeen Name(print) Q meg , -1
Address q,�Ij 'jci r7cr t4- l�'V-
payable
Check
to: City, St,Zip LL,0 '
Signature: Approved by:
Date: Date:
Revised 3-2-07 by Business Services;
Shared/Forms and Templates/Business Service Forms/Employee Exp Reimb Request 2007-3 NOV 1 .9 2013
I1R°r.
PRISCRIBED BY STATE BOARD OF ACCOUNT; J GENERAL FORM NC,IQ)(1980
MILEAGE CLAIM
CCU —� sr _ TO
tOOVFAN-7-UNlii
ON ACCOUNT OF APPROPRIATION NO. FOR
[OFFICE,BOARD.DEIAXYMEXr OR INSITrU ION)
SPEEDOMETER AUTO J41LEAGE
DATE FROM TO READING +
NATURE OF BUSINESS MILES
V J— POINT POINT START FJNISH TRAVELED PER JUTE
45 L
J,
L _
�1 11i ly __..
i) L
1
AUTO LICENSE NO.
TOTALS
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1993,I hereby certify that the foregoing account is just and correct,that the amount claimed is legally due er towing all just credits
end that pop rt of th same has been paid.
Date
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Wt.a AGE CLAIM J C,rn e�:
ON ACCOUNT 07 APP80PMAUON NC? yon
DATE PROM TO 1t8ADII7(i AUTO t9LIIACdA
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PONY PQIIOT 8f'ART P7N19$ NATURE Oy BUMXM TA D
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AUCO LECWW NO. TOTALS
+ SPMOMU MDJX(3 calunm am to he used only whoa dint""botg m points cannot be determined by fined m9sage or oHlolsl ht9hway map.
Nunment to o provlda a and pema uw of Chapter 188,Acts 1893.I hereby car*that the foragotgg account is just and correct,that the amount clatmcd to legally r allaatng all juat aredids
end that has been paid.
to I `
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at Bl�ll OR ACCOUNT OP APMOFRIATWM NO: 8OH
MR.MM smism as mgmam
FROM
TO RIIAMW A�tlYO1 tltlSAt3E
POW POW grin F M9Ft NATO OF tttlsttllstss
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+ SPf=hfS n=DING coh mm an to be=ad only whim distance between polnio cannot be determined by&od nin gape or cffiolal kichr"ay swap.
Paranant to tho prwtstonc and p*u4dos of Chapter 188,Acts 19.53,thereby co fy that the ioragaing account is lnat and correct,lhat tlta aamtnrt cleimad is legally dna, r owing all drat e. w�---
ead that no of o boon paid.
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
11/18/13 Reimb. Supplies $ 56.10
11/19/13 Reimb. Mileage 815 - 11/15/13 $ 329.95
Total $ 386.05
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$
$ 386.05
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-3 Reimb. 4239039 $ 56.10 1 hereby certify that the attached invoice(s), or
1081-3 Reimb. 4343000 $ 329.95 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
27-Nov 2013
Signature
$ 386.05 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund