247361 07/1 5/1 5 Q
CITY OF CARMEL, INDIANA VENDOR: 355319
CHECK AMOUNT: $********50.00*ONE CIVIC SOUAfjE MICHAEL KLITZINGCARMEL, INDIANA 46032 1550 REDSUNSET DRIVE CHECK NUMBER: 247361
BROWNSBURG IN 46112 CHECK DATE: 07/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4344100 50.00 CELLULAR PHONE FEES
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Carmel • Clay
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
July reimbursement for
6/12/2015 Verizon Wireless 101 1125-1-00-4344100 Cellular Phone Fees $50.00 personal phone for Department
business
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $50.00
Employee Name(print) Michael Klitzing
Address 1550 Redsunset Dr. C �r "�
Check
payable to: City, St, Zip Brownsburg, IN 46112 JUL 4 201
[B7Y:
Signature: Approved_by: '
_____ ._ Date: 7/8/2015 Date:
Business Services Division,Revised 7-7-08
FILE: Shared\Administrative\Forms\Staff Forms\Employee Exp Reimb Request
Manage Your Account Account Number Date Due
P.O�BOX4002 4808 00DO 07/07/15
ACWORTH ,GA 30101
Change your address at Invoice Number 3258823610
vzw.com/changeaddress
0019897 01 AV 0.388 "AUTO T9 3 4212 46112-773450 -C07-P19916-I Quick Bill Summary May 13 Jum 12
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MICHAEL W KLITZING Previous Balance(see back for details) $118.81
1550 REDSUNSET DR Payment—Thank You —$118.81
BROWNSBURG,IN 46112-7734
Balance Forward $:00
Monthly Charges $83.99
Usage and Purchase Charges
Voice $.00
Messaging
Data $.00 ---
I
Equipment Charges $27.08
Verizon Wireless'Surcharges
Veriion,Wireless'News _ and Other Charges&Credits $3.54
A New Look For My Verizon Taxes,Governmental Surcharges&Fees $4.20
We've redesigned the My Verizon Home Total Current Charges $118.81
page so managing your account is
easier.With a new look and simpler
navigation,it's easy to stay up-to-date
on your usage,billing arld what matters Total Charges Due by July 07, 2015 $118.81
most to you.Visit vzw.com/myverizon.
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Get the latest deals on
THE LATEST ACCESSORIES.
Visit go.vzw.cbm/deals
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Pay from wireless Pay on the Web Questions:
#PMT(#768) My Verizon at wwwmzw�_com 1.800.922�0204 or*611 from your wireless
-=-----------------—_-- --------------=- -= ------=--- -- - ---------- ----- ---.____---- --- --- -=--------------------------------
Very nwireless Bill Date June 12,2015
L` Account Number 480813963-00001
Invoice Number 3258823610 Please Recycle
MICHAEL W KLITZING j
1550REDSUNSETDRi Total Amount Due by July 07, 2015
BROWNSBURG,IN 461112-7734
Make check payable to Verizon Wireless. $118.81
Please return this remit slip with payment. + v v
Scan To Pay Or Go Paperless
Pay your bill online,or enroll in Paperless Billing P.O.BOX 25505
or Auto Pay.Simply scan the QR code with your LEHIGH VALLEY, PA 18002-5505
mobile device or visit 16.com/myverizon. o-
Check here anld fill out the back of this slip if your billing address I'1111'IIII"II"111111'11111'll'lll'llllllll"IIIII�I11111111111
has changed or you are adding or changing your email address.
I
32588236100104808739630000100000011881000000118818
NOTICE-13 k account and routing numbers will be retained to enable future payments by phone or online.To opt out,call 1-866-544-0401.
veriLnwireless Invoice Number Account Number Date Due Page
I 3258823610 480873963=00001 07/07!15 2 ofi 5
Get Minutes Used Get Data Used Get Balance
SEND" #DATA+SEND :A1
Explanation of Charges Payments
Verizon Wireless'Surcharges Previous Balance $118.81
Verizon Wireless' Surcharges include (i) a Regulatory Charge
(which helps defray various government charges we pay including Payment—Thank You
government number administration and license fees); (it) a Payment Received 06/05/15 —118.81
Federal Universal Service Charge (and, if applicable, a State
Universal-Service Charge)to recover charges imposed on us by Total Payments —$118.81
the government to support universal service; and (iii) an Balance Forward $.��
Administrative Charge, which helps defray certain expenses we
incur, including:charges we, or our agents, pay local telephone
companies for delivering calls from our customers to their
customers; fees and assessments on our network facilities and
services; property taxes; and the costs we incur responding to
regulatory obligations. Please note that these are Verizon
Wireless charges,not taxes.These charges,and what's included,
_ are subject to change from time to lime.
Taxes,Governmental Surcharges and Fees
Includes sales, excise and other taxes and governmental
surcharges and tees that we are required by law to bill
customers.These taxes,surcharges and fees may change from
time to time without notice.
Late Fee Information
A late payment applies for unpaid balances.The charge is the
-greater of$5 or 1.5%per month,or as permitted by law.
Verizon Wireless'Other Charges and Credits
Includes charges for products and services,and credits owing.
Correspondehd6 Address Verizon Wireless Attn Correspondence Team PO Box 5029'WalUngford,`CT OG492
Automatic Payment Enrollment for Account:480873963-00001 MICHAEL W KLITZING
By signing below,you authorize Verizon Wireless to electronically debit your bank account each month for the total balance due on your account.The check you send will be used to
setup Automatic Payment. You will be notified each month of the date and amount of.the debit 10 days in advance of the payment. I understand and accept these terms. This
agreement does not alter the terms of your existing Customer Agreement.I agree that Verizon Wireless is not liable for erroneous bill statements or incorrect debits to my account.To
withdraw your authorization you must call Verizon Wreless.Check with your bank.for any charges.
1.Check this box. 2.Sign name in box below,as shown on the bill and date. 3.Return this slip with your payment.Do not send a voided check.
■
Changing your billing address for Account:480873963-00001 MICHAEL W KLITZING
Use this space or sign in to My Verizon at vzw.comlchangeaddress to change the mailing address where we send your bill.If we do not have your most recent email address,provide it
below and we'll use it to tell you important information about your Verizon Wireless seivice.Allow 2 billing cycles for the address change to take effect.
New Address Confirming or changing your service address
For each of your mobile numbers,in order to bill taxes and
City surcharges correctly we need a service address-which is a
street address(not a PO Box)that is the home or primary
State/Zip business address of the person who uses that number.To
Work Phone Home Phone confirm or change the service address for any of your mobile
numbers,sign in to My Verizon at vzw.conVserviceaddress.
Email
0019897-0074134-0000002 of 0000006-C07-LTA212-19916
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to bel 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. j
Payee
Purchase Order No.
355319 Klitzing, Michael Terms
i
1550 Redsunset Dr Date Due
Brownsburg, IN 46112
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
7/8/15 Reimb Cell phone Jul'15 $ 50.00
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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
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Voucher No, Warrant No.
355319 Klitzing, Michael Allowed 20
1550 Redsunset Dr
Brownsburg, IN 46112
In Sum of$
50.00
ON ACCOUNT OF APPROPRIATION FOR
I
101 General Fund
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#-
1125 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 acid
received except
July 9, 2015
1P
Signature
$ 50.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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