155338 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 359178 Page 1 of 1
ONE CIVIC SQUARE CHRISTINA HOTZE
CARMEL, INDIANA 46032 14705 WHITE TAIL RUN CHECK AMOUNT: $27.23
N08LESVILLE IN 46060 CHECK NUMBER: 155338
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CHECK DATE: 111012008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4239099 27.23 OTHER MISCELLANOUS
Carm y JAN' 0 P 2003
Parks &Recreation
Employee Ex Expense Reimbursement Request
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Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
2 rS X 1 7 3 -56a3o z4, 3 0 7 9 c;�3
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All receipts should be attached in the same order as listed above. Ts T 2 a, No sales tax will b r T
Employeen Name (print)
Address I W ►'f k 1 CAA) kr
Check /fl ff��11
payable to: City, St, Zip
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Signature: Approved by:
Date: 2Of 0 7 Date: I Z d
Revised 3 -2 -07 by Business Services.
Shared /Forms and Templates /Business Service Forms /Employee Exp Reimb Request 2007 -3
ACCOUNTS PAYABLE
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.
Tina Hotze Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/20/07 Reimb Req Staff mtg. pizza 27.23
Total 27.23
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Tina Hotze Allowed 20
In Sum of
27.23
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1047 Reimb Req 4239099 27.23 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
4 -Jan 2008
Sig t e
27.23 Business S es Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund