194100 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 363878 Page 1 of 1
ONE CIVIC SQUARE SUSAN BEAURAIN CHECK AMOUNT: $50.00
CARMEL, INDIANA 46032 3737 KNICKERBOCKER PLACE 2 D
INDPLS IN 46240 CHECK NUMBER: 194100
CHECK DATE: 2/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4344100 50.00 CELLULAR PHONE FEES
110 0 0
Carmel P- Clay
arks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
1/6/2011 AT &T 1091 4344100 Cellular Phone Fees 50.00 Personal Cell Phone Use
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $50.00
Employee Name (print) Susan Beaurain
Address 3737 Knickerbocker Place
Check
payable to: City St, Zip Indianapolis IN 46240
Signature: Sla o Approved by:
Date: 1/7/2011 Date: '7111
Business Services Division, Revised 7 -7 -08
FILE: Shared \Administrative\Fcrms\S €aff Forms\Employee Exp Reimb Request 1 0 2011 U tsJ
AV u
1/6/2011 Payment Confirmation
CK
Payment Confirmation
A ccount Owner: SUSAN BEAURAIN
A ccount Number: 243001754139
V iew Account Profile
Thank you for your payment. Please print CURRENT PAYMENT CHARGES
or save a copy of this confirmation for your Last Payment Received (01- 06 -11) $132.23
records.
Updated Account Balance $0.00
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Credit /Debit Card Information
Confirmation number QPCOAT607850522
Amount $132.23
Date 01/06/2011
Method Debit card
Card type Visa
Card number xxxxxxxxxxxx6283
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ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show, kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
363878 Beaurain, Susan Terms
3737 Knickerbocker place Apt 2D
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
116111 Reimb Cell phone reimbursement 50.00
Total 50.00
l hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
Voucher No. Warrant No.
363878 Beaurain, Susan Allowed 20
3737 Knickerbocker place Apt 2D
Indianapolis, IN 46240
In Sum of$
50.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1091 Reimb 4344100 50.00 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
27 -Jan 2011
Signature
50.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund