HomeMy WebLinkAbout235754 08/13/14 CITY OF CARMEL, INDIANA VENDOR: 365288
ONE CIVIC SQUARE KURTIS BAUMGARTNER CHECK AMOUNT: $********50.00*
CARMEL, INDIANA 46032 16930 KINGSBRIDGE BLVD CHECK NUMBER: 235754
WESTFIELD IN 46074 CHECK DATE: 08/13/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4344100 REIMB 50.00 CELLULAR PHONE FEES
Carmel e Clay
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
7/19/2014 AT&T i8ctl H5LH l v r $ 50.00 Cell Phone Reimbursement
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $50.00 ,
Employee Name(print) Kurtis Baumgartner
JUL 2 1 2014
Address 16930 Kingsbridge Blvd BY
Check •----_--.-�___,..�
payable to: City, St, Zip Westfield, IN 46074
s
Signature: Approved by:
Date: 7/16/2014 Date: 2jr
Business Services Division,Revised 7-7-08
FILE: Shared\Forms\Business Services\Employee Exp Reimb Request '
i V
DUE BY: Jul 19, 201.4 $181.18
KURTIS BAUMGARTNER
Account Number 243007377604 16930 KINGSBRIDGE BLVD
}�} WESTFIELD,IN 46074-7800
l Please include account number on your check.
Make checks payable to:
CHECK FOR AUTO PAY AT&T MOBILITY
(SEE REVERSE) PO BOX 6416
CAROL STREAM IL 60197-6416
97400243DO737760400DDODD001811800000018118D03
3174.10.403.91526 1 AV 0.381 6n AutoPay Enrollment '
If I enroll in AutoPay,I authorize AT&T to pay my bill
�Illl����lll��l��llili�i�llilllllnn�llll��lnil�lllllllillll�ll monthly by electronically deducting money from my bank
account.I can cancel authorization by notifying AT&T at
KURTIS BAUMGARTNER www.att.com or by calling the customer,care number
16930 KINGSBRIDGE BLVD listed on my bill
WESTFIELD IN 46074-7800 Bank Account Holder Signature:
Date:
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, rice per unit, etc.
P P
Payee
Purchase Order No.
365288 Baumgartner, Kurtis Terms
16930 Kingsbridge Blvd
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
7/19/14 Reimb Cell phone reimbursement Jun"4 $ 50.00
Total Is 50.00
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
i
Voucher No. Warrant No.
365288 Baumgartner, Kurtis Allowed 20
16930 Kingsbridge Blvd
Westfield, IN 46074
In Sum of$
$ 50.00
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#orBoard Members
Dept# INVOICE NO. CCT#/TITL AMOUNT
1091 Reimb 4344100 $ 50.00 1 hereby certify that the attached invoice(s), or
jbill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
j received except
I
i
7-Aug 2014
Signature
$ 50.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I