163237 09/03/2008 CITY OF CARMEL, INDIANA VENDOR: 360464 Page 1 of 1
e i ONE CIVIC SQUARE LINDSAY HOLAJTER CHECK AMOUNT: $124.00
CARMEL, INDIANA 46032 6628 BEAR CREEK DRIVE APT 1424
INDIANAPOLIS IN 46254 CHECK NUMBER: 163237
CHECK DATE: 913/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER A MOU NT DESC
1125 4359000 124.00 SPECIAL PROJECTS
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Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor Vendor listed on receipt Line Budget Description Amount Purpose of Expense
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l All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: I s I DO
Employees Name (print) h 4l k AUG 11 zp�g
Check
Address �B Ki V Z� BY payable to: City, p
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Signature: Approved by:
Date: f U� Date:
Revised 3 -2 -07 by Business Services;
Shared /Forms and Templates/Business Service Forms(Empioyee Exp Reimb Request 2007 -3
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.
360464 Lindsay Holajter Terms
6628 Bear Creek Dr., Apt 1424 Date Due
Indianapolis, IN 46254
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8113108 Reimb. Staff bbq raffles 124.00
Total 124.00
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
i
Voucher No. Warrant No.
360464 Lindsay Holajter Allowed 20
r
In Sum of
124.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1125 Reimb. 4359000 124.00 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
18 -Aug 2008
Signature
124.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund