192011 11/23/2010 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
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ONE CIVIC SQUARE TIFFANY BUCKINGHAM
CARMEL, INDIANA 46032 5130 PRIMROSE AVE CHECK AMOUNT: $19.27
INDIANAPOLIS IN 46205
CHECK NUMBER: 192011
CHECK DATE: 11/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 19.27 GENERAL PROGRAM SUPPL
Carmel o Clay
Parks &Recreat
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
1 I hoc b� _Z- 14X39Q3� gCyvc �(Cc av �q ,2�
Alf receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: ,c 2-7
Y l y✓I
Employee Name (print) O
Address
Check 1
payable to: City, St, Zip `V AJ 4 ZC�
?S
Signature: CiVV Approved by: Q
Date: Date:
Business Services Division, Revised 7 08
FILE, Shared \Administrative\FormslStaff Forms\Employee Exp Reimb Request N' V r�
�010
BY:
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.
358408 Buckingham, Tiffany Terms
5130 Primrose Ave
Indianapolis, IN 46205
invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1115110 Reimb. Club supplies 19.27
Total 19.27
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.
358408 Buckingham, Tiffany Allowed 20
5130 Primrose Ave
Indianapolis, IN 46205
In Sum of
19.27
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -2 Reimb. 4239039 1927 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
18 -Nov 2010
Signature
19.27 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund