189883 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 362444 Page 1 of 1
ONE CIVIC SQUARE MATT LEBER CHECK AMOUNT: $150.00
CARMEL, INDIANA 46032 768 EAST 93RD DR. APT A
INDIANAPOLIS IN 46240
CHECK NUMBER: 189883
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 REIMB 150.00 GENERAL PROGRAM SUPPL
Carmel ®Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
8/10/2010 USA Table Tennis 1096 50 4239039 $150.00 USATT tournament fee
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $150.00
Employee Name (print) HMK Lt6 0 10
Address I ft Z4 ��cxr C i r c1N (Ij
Check
payable to: City, St, Zip --I5HM TN (k(..o ,If(
Signature: �P�Lr^ Approved by:
Date: /L Date: 4 /Z4
Business Services Division, Revised 7 -7 -08
FILE: SharedWdministrative\Forms\Staff Forms\Employee Exp Reimb Request
11m
�l
9 Olympic Plaza Colorado Springs, S t r 0 2 2010
Colorado 80909 -5769 p�
BY........................
RECEIPT
Date: August 10, 2010
7i T�_. T I 1
[xeielVed 1 FOEIi. 1 V la t l heW A. Le
One Hundred Fifty 00/100 Dollars
Paid:
Credit Card XX The MCC Fall Open 9/2/2010
Money Order: No.
T ;ank YOU.
USA TABLE TENNIS
Signature:
United States U S A I
Olympic
9 Olympic Plaza Colorado Springs, Colorado BO909 -5769 Committee
Telephone 799.866.4583 FAX 799 632.6079 i+�
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 46038
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
911/10 Reimb. USATT tournament fee 150.00
Total 150.00
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.
362444 Leber, Matt Allowed 20
11824 Garden Circle West
Fishers, IN 46038
In Sum of
150.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -50 Reimb. 4239039 150.00 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
9 -Sep 2010
Signature
150.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund