186735 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 360484 Page 1 of 1
ONE CIVIC SQUARE AMY BALDAUF CHECK AMOUNT: $91.11
CARMEL, INDIANA 46032 126 LARK DR
M, oN`a APT CHECK NUMBER: 186735
CARMEL IN 46032
CHECK DATE: 6123/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4239039 91.11 GENERAL PROGRAM SUPPL
Carmel 0 Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
1 2-110 Me` r -��35 Qawcfaa 2-(,o,9 Cam?su ifs- ocr
r J 2m �2- '�n�39 Gc S-�, 116 bq 13 vl" Surn C Yv`7 S (ji p1 1e5
f ll receipts should be attached in the same order as listed above. G
sales tax will be reimbursed. TOTAL:
Employee Name {print} JUN
010
Address 121-D Lr K IDr\v,�- 6-
Check
payable to: City, St, Zip C�,� mel, �I l� �3Z
Signature: try Approved by:
Date: 5L Date:
Business Services Division, Revised 7 -7 -48
FILE: Shared Wdministrative\Forms\stafi 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.
360484 Baldauf, Amy Terms
126 Lark Dr., Apt. D Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5131/10 Reimb Summer camp supplies 9111
Mileage 1211/09 4/27/10
Total 91.11
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
360484 Baldauf, Amy Allowed 20
126 Lark Dr., Apt. D
Carmel, IN 46032
In Sum of
91.11
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -99 reimb. 4239039 91.11 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
17 -Jun 2010
Signature
91.11 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund