249601 09/23/15 CITY OF CARMEL, INDIANA VENDOR: 365288
® i'r ONE CIVIC SQUARE KURTIS BAUMGARTNER CHECK AMOUNT: $**......50.00"
CARMEL, INDIANA 46032 16930 KINGSBRIDGE BLVD CHECK NUMBER: 249601
WESTFIELD IN 46074 CHECK DATE: 09/23/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4344100 REIMB 50.00 CELLULAR PHONE FEES
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
9/4/2015 AT&T 1091 4344100 Cellular Fees $ 50.00 August Reimbursement
fNo
receipts should be attached in the same order as listed above.
sales tax will be reimbursed. TOTAL: $50.00
Employee Name(print) Kurtis Baumgartner
Check Address 16930 Kingsbridge Blvd
payable to: City, St, Zip Westfield, IN 46074
Signature: Approved by:
Date: 9/4/2015 Dater 91It 1
Business Services Division,Revised 7-7-08 - � _ 7
FID
FILE: Shared\Forms\Business Services\Employee Exp Reimb Request
SEP 14 2015
BY:
DUE BY: Sep 15,2015 . $97.47
Past Due Charges-$0.10 KURTIS BAUMGARTNER
p� Account Number 243007377604 WEE IELD,I 4607 BLVD
a`&t 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
974002430073776040000000000973700000009747009
9870.3.94.21149 1 AV 0.391 6n AutoPay Enrollment
If I enroll in AutoPay, I authorize AT&T to pay my bit[ monthly
I'illll�'II'II�III��III�"I'I�IIIII�I"I��I��II'I�'ll�'llll'�IIII by electronically deducting money from my bank account.I can
cancel authorization by notifying AT&T at www.att.com or by
KURTIS BAUMGARTNER catling the customer care number listed on my bill.Your
16930 KINGSBRIDGE BLVD enrollment could take 1-2 bitting cycles for AutoPay to take
WESTFIELD IN 46074-7800 effect.Continue to submit payment until page one of your invoice
reflects either AutoPay will Debit Your Bank Account by or
AutoPay will Debit Your Credit Card by.
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, 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
9/4/15 Reimb Cell phone reimbursement Aug'15 $ 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
120
Clerk-Treasurer
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#or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept#
1091 Reimb 4344100 $ 50.00 i 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
September 17, 2015
Ndtby(PJ1J
Signature
$ 50.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund