181822 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
ONE CIVIC SQUARE TIFFANY BUCKINGHAM
CHECK AMOUNT: $16.82
s, ONE CIVIC
INDIANA 46032 5130 PRIMROSE AVE
4 INDIANAPOLIS IN 46205 CHECK NUMBER: 181822
«ON
CHECK DATE: 2/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 16.82 GENERAL PROGRAM SUP PL
7Ci :4LcCe
J
r im ®r
(R6 400'5i1 1 01
Right Store. Right Price.
1217 S. RANGELINE RD.
317 896 48113
YOUR CASHIER WAS Ellen
KRO ICECRM PC 3.49 F
S' 4539 PLUS CARD SAVINGS 1 .99
CHIPS AHOY 3.28 F
CHIPS AHOY 3.28 F
KRO ICECRM PC 3.49 F
SC 4539 PLUS CART) SAVINGS 1.99
CHIPS AHOY 3.28 F
KROGER PLUS CUSTOMER *4860
TAX 0.00
TAX EXEMPTION 0.00
BALANCE 16.82
*7955
RFFU: 800041
PURCHASE: 16.82
CASHBRCK: 0.00
TOTAL: 16.82
CREDIT CARD 16.82
CHANGE 0.00
TOTAL NUMBER OF ITEMS SOLD 5
KROGER SAVINGS
KROGER PLUS SAVINGS 3.98
TOTAL SAVINGS (19 pct.) 3.98
KROGER SAVINGS
01/15/10 01 ,,,•n 959 8 74 130
*k*
Fuel Points Explrins 01/31/10 308
Save $0.10 off per gallon on 1 fillup
for every 100 Fuel Points
Fuel Points This Order 16
Fuel Points Expiring 02/28/10 155
See Store ror Del,,ils Restrictions
Or Visit www.kroger.com
*SEE WHAT YOU ARE SAVING TODAY*
YOU SAVED $3.98
WITH YOUR PLUS CARD
BY USING YOUR KROGER PLUS CARD,YOUR
ANNUAL_ SAVINGS TO DATE IS $39.24
THANK YOU FOR SHOPPING KROGER
CUSTOMER SERVICE IS EVERYONE'S JOB.
LET ME KNOW HOW WE ARE DOING.
CHARL BECHEL, MANAGER
Carrel 0 Clay ��a
Parks &Recreation -ek
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
i /1 5- 111) re r vo,k6 �IU1 <A -W 41 ,gz c.,* s
'All receipts should be attached in the same order as listed above_
No sales tax will be reimbursed. TOTAL: 1 1 I o 2_.
Employee Name (print) 0, 1 v(:6,44#aviA
Address R{ l vy\ (0 5f k/('
Check h r I
payable to: City, St, Zip +\d) )vAaTO\IS I ,/!V U25S
i.:, Si via 1 ULL AakV( Approved by:
Date: j q- i n Date: I a'Q -(.0
Business Services Division, Revised 7 -7 -08
FILE: SharedlAdministrative \Forms\Staff Forms\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
Purchase Order No.
358408 Buckingham, Tiffany Terms
5130 Primrose Ave
Indianapolis, IN 46205
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/19/10 Reimb. Club supplies CT 16.82
Total 16.82
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
Voucher No. Warrant No.
358408 Buckingham, Tiffany Allowed 20
5130 Primrose Ave
Indianapolis, IN 46205
In Sum of
16.82
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or Board Members
INVOICE NO. ACCT #!TITLE AMOUNT
Dept
1081 Reimb. 4239039 16.82 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
28 -Jan 2010
YPt 2 7 /A
Signature
16.82 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund