183392 03/16/2010 CITY OF CARMEL, INDIANA VENDOR: 362749 Page 1 of 1
ONE CIVIC SQUARE KELSEY MILLER
CHECK AMOUNT: $192.00
CARMEL, INDIANA 46032 13259 EnsTwooD LN
FISHERS IN 46038 CHECK NUMBER: 183392
CHECK DATE: 311 612 01 0
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMS 192.00 GENERAL PROGRAM SUPPL
I
Ca rmel ay
Parks Recreat on
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line
IS Description Amount P urpose of Expens
All receipts should be attached in the same order as listed above. I eft
No sales tax will be reimbursed. TOTAL:
i i�
C MAR 0 2 2010
Employeen Name (print) M l
13 2 s �n BYo
Address
'Check
payai3le to: City, St, Zip i�
Signature: Vim- I Approved by:
Date:
o Date: -C O
Revised 3 -2 -07 by Business Services;
Shared /Forms and Templates /Business Service FormstEmployee Fcp Reimb Request 2007 -3
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEN
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.
362749 Miller, Kelsey Terms
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
2125110 Reimb. Program supplies 192.00
Total 192.00
1 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.
362749 Miller, Kelsey Allowed 20
In Sum of
192.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #rFITLE AMOUNT Board Members
Dept
1081 -5 Reimb. 4239039 192.00 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
11 -Mar 2010
Signature
192.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund