186403 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 362444 Page 1 of 1
ONE CIVIC SQUARE MATT LEBER CHECK AMOUNT: $152.95
CARMEL, INDIANA 46032 768 EAST 93RD DR APT A
y pN `a INDIANAPOLIS IN 46240 CHECK NUMBER: 186403
CHECK DATE: 619/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 152.95 GENERAL PROGRAM SUPPL
Carmel Clair
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
L� Receipt Vendor listed on receipt I Lin Budget Description J `CI Amount Purpose of Expense
I •(w lJ �rb�rGc)� I V L, i Gble E e>7/1 `S j Gurnc,rr�
All receipts should be attached in the same order as listed above. T515 z i q
No sales tax will be reimbursed. TOTAL:
�a
Employee Name (print) M a:�` Le r
Address 1 IS2`t (�;i rLll% 1��� j C7� 1►
Check BY. .S�"
payable to: City, St, Zip �1� o,3 ,3g o °n
Signature: &L y4eLz Approved by: T�, Rrkr t t V
Date: 4 IS LO Date:
Business Services Division, Revised 7 -7 -08
FILE: SharedlAdministrative \Forms\Staff Forms%Employee Exp Reimb Request
Natb nalCky. Gift Card Registration
Non- Personalized
A. BANK USE ONLY
Card Number Issued Amount to Load on Card
Must be whole dollar amounts between $25 -$500
4436981533529241 150.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
t Sub Total:
150.00
Activation Fee:
L.bJ
TOTAL CHARGE:
152.95
Date Activated Region Branch Tefler Number
4/26/2010 0060 00373 01
B. PURCHASER INFORMATION
Purchaser First Name M.I. Purchaser Last Name
MATTHEW LEBER
Home Phone Purchaser Tax ID Number (Optional)
419 681 -2072 000000000
Purchaser Address 1
768 E 93RD DR APT A
City state Zip
I IN 46240
MAY 2 4 1010
BY:
Retain in Branch Folder
(Rev. 05102106) MCD096CP
National City Online Banking Page 1 of 15
PRINT CLOSE
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Purchase n
Description I b, �I zc M on
View Account Activity P.O.# "C 00CZ�� Pore
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To print this page, select the print button above. Budget
Line Desdl n-� v
Date: 04/28/2010 Purchaser pate Ib
Account: Checking C Lei v ,�p ,n Approval Data
9 1� Jr C,i° ELI f J
Current Balance:
Available Balance:
Available Balance does not include overdraft protection, if applicable. 'M =Check Image
DATE DESCRIPTION TYPE DEBIT( CREDIT( RUNNING
BALANCE
PENDING ITEMS
=04/28/2010 CASHED CHECK TELLER 2106001373 $152.95
POSTEDITEMS
04/27/2010
li
https:// onlinebanking .nationalcity.com/OLB/ secure /AccountActivityPrint .aspx ?AE =kCrG... 4/28/2010
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.
362444 Leber, Matt Terms
11824 Garden Circle West
Fishers, IN 4£038
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
4/28/10 Reimb. Table Tennis Tournament Prize money 152.95
Total 152.95
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.
362444 Leber, Matt Allowed 20
11824 Garden Circle West
Fishers, IN 46038
In Sum of
152.95
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO#or INVOICE NO. 4CCT #1TITL AMOUNT Board Members
Dept
1096 -50 Reimb. 4239039 152.95 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
Signature
152.95 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund