319733 12/15/17 �4gMf� CITY OF CARMEL, INDIANA VENDOR: 355319
d it ONE CIVIC SG'UARE MICHAEL KLITZING CHECK AMOUNT: $""""100.00•
CARMEL;INDIANA 46032 1550 REDSUNSET DRIVE CHECK NUMBER: 319733
BROWNSBURG IN 46112 CHECK DATE: 12/15/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4344100 REIMB 100.00 CELLULAR PHONE FEES
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Voucher No. Warrant No.
355319 Klitzing, Michael Allowed 20
1550 Redsunset Dr
Brownsburg, IN 46112
In Sum of$
$ 100.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 Reimb 4344100 $ 100.00 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
December 14, 2017
Signature
$ 100.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Carmel ® Clay
Parks&Recreation Y
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
Reimbursement for use of
10/12/2017 Verizon Wireless 101 1125-1-00-4344100 Cellular Phone Fees $50.00 personal phone for Department
business
Reimbursement for use of
11/12/2017 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: $100.00
Employee Name(print) Michael Klitzing
Address 1550 Redsunset Dr.
Check
payable to: City, St, Zip Brownsburg; IN 46112
Signature: . Approved by:
Date: 12/11/2017 Date:
Business Services Division,Revised 7-7-08
FILE: Shared\Administrative\Forms\Staff Forms\Employee Exp Reimb Request