186222 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 357435 Page 1 of 1
0 ONE CIVIC SQUARE ANDREW BURNETT CHECK AMOUNT: $59.16
CARMEL, INDIANA 46032 9215 N. PARK AVENUE
INDIANAPOLIS IN 46240 CHECK NUMBER: 186222
CHECK DATE: 6/9/2010
DEPARTMENT ACC OUNT PO N UMBER INVOICE NUMBER A MOUNT DESCRIPTION
1125 4238000 REIMB 59.16 SMALL TOOLS MINOR E
Carmel e Clay
Pa rks
Employee Expense Reimbursement Request
Date of
Receipt Vendor listed on receli t Fund Department Account Line Account Description Amount Purpose of Ex ense
S
5 1 1 Lo
en
All receipts should be attached in the same order as listed above.
TOTAL
Name (print) 0�1 y�x
Check Address
payable to:
City, St, Zip
Signature J "W" Date: 71 N
Approved by: Date:
Revised 3 -2 -07 by Business Services
JUN 0 1 2010
"'r
ACCOLiNTS 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.
357435 Burnett, Andrew Terms
9215 North Park Avenue Date Due
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5127/10 Reimb parts for sign installation at Flowing well 59.16
Total 59.16
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
1
Voucher No. Warrant No,
357435 Burnett, Andrew Allowed 20
9215 North Park Avenue
Indianapolis, IN 46240
In Sum of
59.16
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
r
1125 reimb. 4238000 59.16 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
3 -Jun 2010
a
Signature
59.16 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I