173419 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 362444 Page 1 of 1
ONE CIVIC SQUARE MATT LEBER CHECK AMOUNT: $100.00
f CARMEL, INDIANA 46032 768 EAST 93RD DR. APT A
INDIANAPOLIS IN 46240 CHECK NUMBER: 173419
CHECK DATE: 6110/2009
DEPARTMENT AC COUN T PO NUMBER INVOICE NUMBER AMOUNT D ESCRIPTION
1047 4239039 100.00 GENERAL PROGRAM SUPPL
i
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
:5A G V �1 i 2G �fZ3 7 LX22'm QQ 0 d Y bu rfa^ f Uioh -e
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
Employee Name (print) MAY 2 1
2009
Address 7 �0 (c� �C P'�
Check ,,11
payable to: City, St, Zip Iri I,ty)Gt L T 'TL)
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Signature: ffia z i Approved by:
Date: -�ZJ Date: 1 M Ioq
Business Services Division, Revised 7 -7 -08
FILE: Shared\Administrative \Forms \Staff Forms \Employee Exp Reimb Request
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One Olympic Plaza Colorado Springs,
Colorado 80909-5769
R ECEIPT
Date: 5- May -09
Received From: Matthew Leber
One hundred and 00 /xx Dollars
Paid: Check #558 (Rcvd 3/23/09) and Check #591 (Rcvd 4/3/09)
Cash 0
Money Order: El No.
Thank you.
USA TABLE TENNIS
Signature:
Group A Member
"a
pq
One Olympic Plaza Colorado Springs, Colorado 80909 -5769 0 k
Telephone 719.866.4583 FAX 719.632.6071
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.
362444 Leber, Matt Terms
768 East 93rd Dr., Apt A
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5113109 Reimb. USA Table tennis tournament sanction fee
100.00
Total 100.00
I 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.
362444 Leber, Matt Allowed 20
768 East 93rd Dr., Apt A
Indianapolis, IN 46240
In Sum of
1
100.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TlTLE AMOUNT Board Members
Dept
1047 Reimb. 4239039 100.00 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
4 -Jun 2009
Signature
100.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund