190836 10/13/2010 CITY OF CARMEL, INDIANA VENDOR: 355133 Page 1 of 1
ONE CIVIC SQUARE AUDREY B KOSTRZEWA
i CHECK AMOUNT: $68.00
CARMEL, INDIANA 46032 2592 TURNING LEAF LANE
"}o. `o CARMEL IN 46032 CHECK NUMBER: 190836
CHECK DATE: 10/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 68.00 GENERAL PROGRAM SUPPL
Ca a Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
Classifed ad for department
9/28/2010 Indianapolis Newspapers 1096 -60 4239039 Gen Program Su plies $68.00 special event
Indpls Newspapers only
accepts credit cards for ads
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $68.00
Q A"/
Employee Name (print) A udrey Kostrzewa 4
Address 2592 Turning Leaf Lane OCT 0
Check
payable to: City, St, Zip Carmel, IN 40632 BY:
Signature: Approved by:
1
Date: 9/29/2410 Date:
Business Services Division, Revised 7 -7 -OS
FILE: Shared \Administrative \Forms \Staff Forms \Employee Exp Reimb Request
SEP -20 -2010 01:45P FROM :THE INDIANAPOLIS STA 3174447373 T0:95714136 P.1/1
T
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INDIANAPOLIS NEWSPAPERS, INC. FAX PROOF
317 5 •y1.3�
Ad Nimber: 5717305 7/-
Customer: CARMEL CLAY PARKS RECREATION Contact: SERRA GARSKE Phone: 3175734020
Price: 68.00
Section: CL Class: 251; GARAGE SALES NORTH
Size: 1 X 11 Start Date: 10/07/2010 End Date: 10/09/20100r-
dered: 7 Times
Class: 251; GARAGE SALES NORTH Printed By: C126 09/28/2010
Signature of Approval: Date:
CARMEL
The Monon comm"Ity
Center No
Sal off of 9(h 10 i 41). /!�[,i
Of(O! pans.1e(nle,
Del Weea 1 ill lIA 11611, U
FREE TO PUBLIC.
L'nnce!!ed r(nlmuQ.
'1Q-3 962 9
rnel
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SEP -20 -2110 01:45P FRDM:THE INDIANAPOLIS STA 3174447373 TO:95714136 P.1'1
�*4 1 T S-ey-rc-L
INDIANAPOLIS NEWSPAPERS, INC. FAX PROOF
Ad limber 5111305
Customer: CARMEL CLAY PARKS RECREATION Contact: SERRA GARSKE Phone: 3175734020
Price: 68.00
Section: CL Class: 251; GARAGE SALES NORTH
Size: 1 K 11 Start Date: 10/07/2010 End Date: 10 /09 /201OOr-
dered: 7 Times
Class: 251; GARAGE SALES NORTH Printed By: C126 09/28/2010
Signature of Approval: Date:
CARMEL
The Monon Community
Cent er kiel
SRI. Ott. 91h 10 a IP.
1275 Cenlral Park Or, E.
0(l e1 R7iltt
Imtwml Wt 1A 1l6lh.
FREE TO PUBLIC.
Gmceded it n1injity.
I
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INDIANA NEWSPAPERS 2479262027228649990064
09/28/2010 09/2912010 Sale ADV(Services and 8 $68.00
Merchandise)
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ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemizedme per hourkn d of s ere er me dates service rendered, by
whom, rates per day, number hours, ra
Payee Purchase Order No.
Terms
355133 Kostrzevva, Audrey Date Due
2592 Turning Leaf Lane
Carmel, IN 46032
Invoice Invoice Description PO Amount
Date Number (or note attached invoice(s) or bill(s))
$68.00
09128110 Reimb Classified ad for special event
C-
Total 68.00
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
i
Voucher No. Warrant No.
355133 Kostrzewa, Audrey Allowed 20
2592 Turning Leaf Lane
Carmel, IN 46032
In Sum of
68.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -60 Reimb 4239039 68.00 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
7 -Oct 2010
Signature
I 68.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I J