168870 02/17/2009 CITY OF CARMEL, INDIANA VENDOR: T362524 Page 1 of 1
0 ONE CIVIC SQUARE LACEY BASARICH
CARMEL, INDIANA 46032 PO BOX 213 CHECK AMOUNT: $20.76
ATLANTA IN 46031
CHECK NUMBER: 168870
CHECK DATE: 2/17/2009
DEPARTM ACCOUNT P NUM BER INVO NUM AMOUNT DESCRIPTION
1046 4239037 REIMB ;20.76 CLUB ACTIVITY SUPPLIE
4
Carmel Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
(0 �1- V 5,
A n16 0, M/ e_� c� r
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: C�
Employeen Name (print)
Check
Address S FEB 0 2 2009
payable to: City, St, Zip BY:
N j�
Signatur Approved by:
Date: C/ Date:
Revised 3 -2 -07 by Business Services;
Shared /Forms and Templates /Business service Forms /Employee Exp Reimb Request 2007 -3
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee Purchase Order No.
Terms
Basarich, Lacey
P.O. Box 213
Atlanta, IN 46031
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
20.76
1123109 Reimb Craft supplies
Total 20.76
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
Basarich, Lacey Allowed 20
P.O. Box 213
Atlanta, IN 46031
In Sum of$
20.76
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE N0. ACCT WTITLE AMOUNT Board Members
Dept
1046 Reimb 4239037 20.76 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
13 -Feb 2009
&2
Signature
20.76 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund