HomeMy WebLinkAbout205875 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 360926 Page 1 of 1
ONE CIVIC SQUARE SHAVONNE HOLTON
CARMEL, INDIANA 46032 3707 N MERIDIAN ST APT 38 CHECK AMOUNT: $25.98
INDIANAPOLIS IN 46208 CHECK NUMBER: 205875
CHECK DATE: 1/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 25.98 GENERAL PROGRAM SUPPL
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
i vS 23g03q C-,e�, Pr r�
i O S
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: I s ZS.
Employeen Name (print) yaf) no 4C�
Address
c) 3GZ Banc co-P� c A-N
Check O JAAM 18 1012
payable to: City, St, Zip
Signature: Approved by: Y
Date: 1 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.
360926 Holton, Shavonne Terms
8001 Canary Ln Apt A Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/16/12 Reimb. General program supplies 25.98
Mileage 6/7 7/13/11
Total 25.98
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
i
Voucher No. Warrant No.
360926 Holton, Shavonne Allowed 20
8001 Canary Ln Apt A
Indianapolis, IN 46260
In Sum of
25.98
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -1 Reimb. 4239039 25.98 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
26 -Jan 2012
Signature
25.98 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund