193376 01/05/2011 CITY OF CARMEL, INDIANA VENDOR: 363734 Page 1 of 1
ONE CIVIC SQUARE AMY AYERS CHECK AMOUNT: $90.00
CARMEL, INDIANA 46032 13165 PLAYER CIRCLE
CARMEL IN 46033 CHECK NUMBER: 193376
CHECK DATE: 1/5/2011
DEPARTMENT ACCOUN PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 AAYRES121110 90.00 TIPS
Brookshire Golf Club
Carmel, Indiana
Substitute Form 4070A
Employee's Daily Record of Tips
Employee Name (please print) ty 4 5 Payroll
Day Date Total Tips Received
Saturday ja C.
Sunday
Monday
j Tuesday
i
Wednesday
Thursday
Friday
i
Total Weekly Tips Cg'
Substitute Form 4070
Employee's Report of Tips to Employer
i'mplo ee's Name and Address Employee's Social Security Number
�yCC
Cash Tips Received from record above
i
E mp loy er's Name and Address Period for which tips were received
City of Carmel From (date)
One Civic Square
Carmel, IN 46032 To date
:_mplo e Signatur Date J
VOUCHER NO. WARRANT NO.
ALLOWED 20
Amy Ayers
IN SUM OF
13165 Player Circle
Carmel, IN 46033
$90.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1207 A Ayersl2 /11/10 42- 390.40 $90.00 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
Monday, December 27, 2010
Director, Brooks ire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/11/10 A Ayers12 /11/10 Tip $90.00
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