200364 08/17/2011 a CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
;l ONE CIVIC SQUARE TIFFANY BUCKINGHAM CHECK AMOUNT: $23.92
CARMEL, INDIANA 46032 5130 PRIMROSE AVE
INDIANAPOLIS IN 46205 CHECK NUMBER: 200364
CHECK DATE: 8/1712011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4239039 23.92 GENERAL PROGRAM SUPPL
Carmel o Clair
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
Zg �l 1 6 Z �I Z3� C� v►e�a (o (a�2 Z 3 P 2 e Ca
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: 23'2 1 Employee Name (print) T f4rw U C,( Y'? 0 X R, VT LIZ w
s L JUL 2011
Address 5� F 2 1 S
Check
payable to: City, St, Zip Yj 90 1 1 S u �Q 2 2 ATP'.
Signature: ot/� Approved by:
Date: t Date:
Business Services Division, Revised 7 -7 -08
FILE: Shared\Administrative \Forms \Staff Forms \Employee Exp Reimb Request
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
7/28/11 Reimb. Supplies 23.92
Mileage 4/25 5/16/11
Totall 23.92
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
23.92
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #frITLE AMOUNT Board Members
Dept
1082 -4 Reimb. 4239039 23.92 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
9 -Aug 2011
V2�-
Signature
23.92 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund