305051 11/14/16 y��.&inti
CITY OF CARMEL, INDIANA VENDOR: 371105
`/ `l CHECK AMOUNT: $********40.00*
.�; ® �• ONE CIVIC SQUARE AMY WOOCK
i•. _�. CARMEL, INDIANA 46032 686 NOTTINGHAM COURT CHECK NUMBER: 305051
9M�roii'�O� CARMEL IN 46032 CHECK DATE: 11/14/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
854 367006 110916 40.00 MAYOR'S YOUTH COUNCIL
VOUCHER NO. WARRANT NO. Prescribed by State Hoard of Accounts City Form No.201 (Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
AMY WOOCK
686 NOTTINGHAM COURT IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
CARMEL, IN 46032 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$40.00 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Community Relations Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
RECEIPTS 3-670.06 $40.00 1 hereby certify that the attached invoice(s),or 9/28/16 RECEIPTS $40.00
1203 854 1203 854
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
Wednesday, November 09,2016
(
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-
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
<1 'r
Reimbursement Expense Receipt
Reimbursement expenses are transactions that were conducted by a third-parry whom
needs a reimbursement on behalf of the CMYC organization_ Transactions such as CMYC
members paying for CMYC event materials would be one example of a reimbursement expense.
After completing this form, please submit it to the Council Clerk-Treasurer.
Expender: �C) J
Vendor(location of purchase): i
Date: 0 f Cj
Event/Activity (if applicable): T Y l S r„„ „
Expense Account(see list of accounts):
Additional Description: - ' $5 ,-(D 0 q(-
J
Expense Amount(do not include Sales Tax): t
Reimbursee Name: /�,,,,, r A I D C
Reimbursee Address (required): (0�-(O I v ( VI G llwry� 0—
I verify to the best of my knowledge that this information is correct, and this purchase was
made on behalf of CWC and not for personal use or gain.
ender Signature Date
Please submit this form to Clerk-Treasurer along with the purchase receipt.
Appendix 14-Page 1
Q
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12697 North Pennsylvania
Carmel IN 46032
(317) 844-4742
Host: Emalee 0c,'ZC,/2016
ORDER-#509 +3 PM
10410
New Gift Card 5.00 /
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Tran:213668
Auth:336077
New Gift Card 5.00
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Auth:253�55
New Gift Card , — 5.00
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T ran:215066 +r a �q
'Auth:545344
New Gift Card 5.00
XXXXXXXXXXXX2359 Tastes good is good
Tran:943899
Auth:525522 12697 North Pennsylvania
New Gift Cartl5.00 Carmel IN 46032,
XXXXXXXXXXXX0689' . (317) 844-4742
Tran:940396 Host: Emalee 09/28/2016
Auth:972944 ORDER4511 8:45 PM
New Gift Card 5.00 10412
XXXXXXXXXXXX1638
Tran:214223 Nev; Cift Card- 5.00
Auth:365333 XXX'XXXXXXXX2415
New Gift"Card 5,.00 ran:941603
XXXXXXXXXXXX4212 Allith:812166
Tran:214689
Auth:799000 Uht otal 5,00
Tax 0.00
Subtotal 35.00
Tax 0.00 TAKE OUT Total 5.00
Discover #XXXXXXXXXXXX9273 5.00
TAKE OUT Total 35,00 Authorizing. .-.
Discover #XXXXXXXXXXXX9273 35..00 Balance Due 5.00
Authorizing. . .
Balance Due. 35.00 Order online at� chipotle.com
Order online at chipotle.com