189371 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 360925 Page 1 of 1
ONE CIVIC SQUARE JENNIFER HOLDER
CARMEL, INDIANA 46032 5716 DURHAM CASTLE CT APT 137 CHECK AMOUNT: $8.33
INDPLS IN 46250
CHECK NUMBER: 189371
CHECK DATE: 8/3112010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 8.33 GENERAL PROGRAM SUPPL
Carmel o Clay
Parks &R ecreate ®n
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
Y
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:'�.�
Employee Name (print) 2 b 61j
Address
Check
payable to: City, St, Zip
Signature: Approved by:
Date: (y Date:
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.
360925 Holder, Jennifer Terms
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)) PO Amount
8.33
814110 Reimb Target
Mileage 618 6123/10
Total 8.33
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,
360925 Holder, Jennifer Allowed 20
LIP In Sum of
8.33
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TlTLE AMOUNT Board Members
Dept
1081 -6 Reimb 4239039 8.33 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.
26 -Aug 2010
T� I fiw
Signature
8.33 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund