241922 02/10/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 365288
CHECK AMOUNT: S""""'50.00'
ONE CIVIC SQUARE KURTIS BAUMGARTNERCARMEL, INDIANA 46032 16930 KINGSBRIDGE BLVD CHECK NUMBER: 241922
WESTFIELD IN 46074 CHECK DATE: 02/10/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4344100 REIMB 50.00 CELLULAR PHONE FEES
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DUE BY: Feb 19, 2015 $181.38
KURTIS BAUMGARTNER
16930 KINGSBRIDGE BLVD
a l&l Account Number 243007377604
WESTFIELD IN 46074-7800
• � 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
9740024300737760400000DDD0181.3800000018138007
1334.2.18.3817 1 AV 0.381 6n AutoPay Enrollment '
If I enroll in AutoPay,I authorize AT&T to pay my bill
�I��"III���IIII���I�I�I��II��IIIIII����I1�11���11'll'lllll���ll� monthly by electronically deducting money from my bank
account.I can cancels authorization by notifying AT&T at
KURTIS BAUMGARTNER www.att.com,or by calling the customer care number
16930 KINGSBRIDGE BLVD listed on my bit[.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 wit[be Debited by or Your Credit
Card will be Debited on or after.
Bank Account Holden Signature:
Date:
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
2/3/2015 AT&T Wireless 1091 4344100 Cell Phone Fees $ 50.00 January 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 `�!�' 'T�Tj�
Address 16930 Kingsbridge Blvd FEB -5 2015
Check
to: Westfield,
payable City, St, Zip IN 46074
Signature: 2Approved by:
Date: 2/3/2015 Date: 2/Yjyi
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
2/3/15 Reimb Cell phone reimbursement Jan'15 $ 50.00
I.
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
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
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i
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITL AMOUNT
I
1091 Reimb 4344100 $ 50.00 1 hereby certify that the attached invoice(s), or
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
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I
February 5, 2015
Signature
$ 50.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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