252545 12/15/15 CITY OF CARMEL, INDIANA VENDOR: 365288
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ONE CIVIC SQUARE KURTIS BAUMGARTNER CHECK AMOUNT: $**......50.00`
i•. ,: CARMEL, INDIANA 46032 16930 KINGSBRIDGE BLVD CHECK NUMBER: 252545
WESTFIELD IN 46074 CHECK DATE: 12/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4344100 50.00 CELLULAR PHONE FEES
5
`c BY: Dec 115;.2015 $97,34
KURTIS BAUMGARTNER
Account Number 243007377604 16930 KINGSBRIDGE BLVD
at
n&� 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
974002430073776040000ODDD00973400000009734001
7054.5.193.41057 1 AV 0.391 6n AutoPay Enrollment
If I enroll in AutoPay,I authorize AT&T to pay my bill monthly
"II"III�I" 'II.��'���I"I..�II��i'lllll��ll�llll'�IIIII'lll'll by electronically deducting money from my bank account.I can
cancel authorization by notifying AT&T at www.att.com or by
KURTIS BAUMGARTNER calling 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 wilt Debit Your Bank Account by or
AutoPay will Debit Your Credit Card by.
Bank Account Holder Signature:
Date:
li
Carmel 0 clay
P'arks&Recreatfon
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on recei t # Line# Budget Description Amount Purpose of Expense
12/15/2015 AT&T 1091 4344100 Cellular Fees $ 50.00 November Cell Reimbursement
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed.
TOTAL: $50.00
C-k_ VED
Employee Name (print) Kurtis Baumgartner - 9 2015
Check
Address 16930 Kin sbrid e Blvd BY:
_-
payable to: City, St, Zip Westfield, IN 46074
Signature: Approved by:
r
Date: 12/7/2015 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
365288 Baumgartner, Kurtis Purchase Order No.
16930 Kingsbridge Blvd Terms
Westfield, IN 46074
Invoice Invoice
Date Description
Number (or note attached invoice(s)or bill(s)) PO#
12/7/15 Reimb Cell phone Nov'15 Amount
$ 50.00
I
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance $ 50.00
with IC 5-11-10-1.6
, 20
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. CCT#/TITLE AMOUNT Board Members
Dept#
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 i s made were ordered and
received except
December 10, 2015
Signature
$ 50.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I