241223 01/22/15 �qq .
CITY OF CARMEL, INDIANA VENDOR: 365288
b r ONE CIVIC SQUARE KURTIS BAUMGARTNER CHECK AMOUNT: $ ...."'50.00"
=4 CARMEL, INDIANA 46032 16930 KINGSBRIDGE BLVD CHECK NUMBER: 241223
�''<ron�°' WESTFIELD IN 46074 CHECK DATE: 01/22/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4344100 REIMB 50.00 CELLULAR PHONE FEES
DUE 6Y: Jan 19, 2015 $181.08
KURTIS BAUMGARTNER
Account Number 243007377604 WEE IELD,I 4607 BLVD
y ^t&t WESTFIELD,IN 46074-7800
d 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
974002430073776040000000001810800000018108006
8862.2.26.6415 1 AV 0.381 6n AutoPay Enrollment
If I enroll in AutoPay,I authorize AT&T to pay my bill
'IIIII'I'IIIII'll'ILII'Ii�ilililllli�lll'lllll,llll,llll"I"I'I 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.Your enrollment could take 1-2 billing
WESTFIELD IN 46074-7800 cycles for AutoPay to take effect.Continue to submit
payment until page one of your invoice reflects either
Your Bank Account will be Debited by or Your Credit
Card will be Debited on or after.
Bank Account Holder Signature:
Date:
J
Carmel a clay
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
1/19/2015 AT&T 1091 4344100 Cellular Phone Fees $ 50.00 Dec. Cell Reimbursement
fN'o
l receipts should be attached in the same order as listed above. /
sales tax will be reimbursed. TOTAL: $50.0 ✓
Employee Name(print) Kurtis Baumgartner- � JAN 12 2015
Address 16930 Kingsbridge Blvd
Check j$'y
payable to:
City, St, Zip lestfield, IN 46074
Signature: Approved by:
Date: 12-Z/IS' Date:
Business Services Division,Revised 7-7-08
FILE: Shared\Forms\Business Services\Employee Exp Reimb Request
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.
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
1/12/15 Reimb Cell phone reimbursement Dec'14 $ 50.00
Total $ 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
1
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
Board Members
PO#or INVOICE NO. CCT#/TITL AMOUNT
Dept#
Dept
4344100 $ 50.00 1 hereby certify that the attached invoice(s), or
1091 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
January 15, 2015
Signature
$ 50.00 Accounts Payable Coordinator
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund