HomeMy WebLinkAbout166407 11/24/2008 CITY OF CARMEL, INDIANA VENDOR: 362215 Page 1 of 1
ONE CIVIC SQUARE BROOKE TAFLINGER
1, CARMEL, INDIANA 46032 3240 S400 w CHECK AMOUNT: $40.00
KOKOMO IN 46902 CHECK NUMBER: 166407
CHECK DATE: 11/24/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4340700 40.00 MEDICAL FEES
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Carmel 0 clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on Line Budget Description Amount Purpose of Expense
101612008 Kaiser Permanente 47 300.000.43407 Medical Fees /Drug Screeninc 40 Drug Screen for Inclusion
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All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: T 40.00
Employee Name (print) Brooke Taflinger P F, C 7
4; Address 3240 South 400 West NOV 1 7008
Check
payable to: City, St, Zip ,Kokomo, IN 46902
Signature Approved by:
�a lob
Date: Date: r�
Business Services Division, Revised 7 -7 -08
FILE: SharedWdministrative�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.
Taflinger, Brooke Terms
3240 S 400 W
Kokomo, IN 46902
Y
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/30/08 Reimb. Drug Screen for Inclusion 40.00
Total 40.00
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
Voucher No. Warrant No.
Taflinger, Brooke Allowed 20
3240 S 400 W
Kokomo, IN 46902
In Sum of
1S
40.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1047 Reimb. 4340700 40.00 1 hereby certify that the attached invoice(s), or
biil(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
17 -Nov 2008
Signature
40.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund