205167 01/05/2012 CITY OF CARMEL, INDIANA VENDOR: 363874 Page 1 of 1
ONE CIVIC SQUARE DEBORAH EGGERT
CHECK AMOUNT: $90.00
CARMEL, INDIANA 46032 1824 WHITE ASH DRIVE
L;,, `off CARMEL IN 46033 CHECK NUMBER: 205167
CHECK DATE: 1/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 KUMP12 -9 -11 90.00 FOOD BEVERAGES
Brookshire Golf Club
Carmel, Indiana
Substitute Form 4070A
Employee's Daily Record of Tips
Employee Name (please print) C� 2��� Payroll l
Day Date Total Tips Received
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Total Weekly Tips $cjr
Substitute Form 4070
Employee's Report of Tips to Employer
Employee's Name and Address Employee's Social Security Number
2,4 W„/ Cash Tips Received from record above
Employer's Name and Address Period for which tips were received
City of Carmel From (date)
One Civic Square
Carmel, IN 46032 To (date)
Employee Signatu C Date l J
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Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/09/11 Kump12 -9 -11 Tip $90.00
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.
ALLOWED 20
Debbie Eggert
IN SUM OF
1824 White Ash Drive
Carmel, IN 46033
$90.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1207 Kump12 -9 -11 42- 390.40 $90.00 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
Tuesday, January 03, 2012
G
Director, Broo shire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund