185759 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 363711 Page 1 of 1
ONE CIVIC SQUARE FREDERICK HAGEMIER
CARMEL, INDIANA 46032 7502 DEAN RD CHECK AMOUNT: $83.43
INDPLS IN 46254
CHECK NUMBER: 185759
CHECK DATE: 5/2612010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4235000 83.43 BUILDING MATERIAL
Carmel a 6U
Parks &Recreation AO 0
E mployee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
5/10/2010 Lowes OA `5 4a35oo Glue /Fiber board /screws Complete Project
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: =$83.43
Employee Name (print) fred Hagemier MAY 8 20
Address 7502 Dean rd.
Check
payable to: City, St, Zip Indian olis In. 46240 5/10/2010
Signatur Approved by
Date: 5/12/2010 Date `01k3 t0
Business Services Division, Revised 7 -7 -08
FILE: Shared\Administrative \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.
Hagemier, Fred Terms
7502 Dean Rd
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5/10110 Reimb Bldg materials 83.43
Total 83.43.
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.
Hagemier, Fred Allowed 20
7502 Dean Rd
Indianapolis, IN 46240
In Sum of
83.43
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO#or INVOICE NO. ACCT#fTITLE AMOUNT Board Members
Dept
1093 Reimb 4235000 83.43 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
20 -May 2010
Signature
83.43 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund