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171068 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 359185 Page 1 of 1 ONE CIVIC SQUARE KATIE SCHNEIDER CARMEL, INDIANA 46032 3211 CHADWOOD LANE N DR #1A CHECK AMOUNT: $347.48 M rug w INDIANAPOLIS IN 46268 CHECK NUMBER: 171068 CHECK DATE: 4/16/2009 DEPA RTMENT ACCOUNT PO NUMBER INVOIC N UMBER AMOUNT DESCRIPTION 1047' 4230200 'f1.95 OFFICE SUPPLIES 1047 4341993 214.58 CATERING SERVICE 1047 4344100 !100.00 CELLULAR PHONE FEES 1125 4342100 10=.95 POSTAGE Carmel 0 Clay Parks &Recreation Employee Expense Reimbursement Request Date of Fund Account Account Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense 2/20/2009 Verizon Wireless 47 100.100.4344100 Cell Phone Fees 50.00 Phone usage 3/20/2009 Verizon Wireless 47 100.100.4344100 Cell Phone Fees 50.00 Phone usage Battery Uharger Tor 3/6/2009 Pa Pal 47 1 100.100.4230200 Office Supplies 21.95 Office Camera 3/31/2009 McAlister's Deli 47 100.100.4341993 Catering Services 59.69 Mgr Retreat Lunch 3/30/2009 Macaroni Grill 47 100.100.4341993 Catering Services 97.63 Mgr Retreat Lunch 4/1/2009 McAlister's Deli 47 100.100.4341993 Catering Services 37.67 Consultant Lunch 4/1/2009 Little Ceasars 47 100.100.4341993 Catering Services 19.59 Guest Services Lunch Ip HandheldS back to 3/30/2009 UPS General Fund Postage 10.95 Vermont S stems All receipts should be attached in the same order as listed above. No sales tax will be reimbursed. TOTAL: $347.48 Employee Name (print) Kate Schneider APR 0 7 2009 Address 3211 Chadwood Lane N Dr Apt 1A Check BY: payable to: City, St, Zip Indianapolis, IN 46268 Signature: Approved by: Date: 4/6/200 Date: Business Services Division, Revised 7 -7 -08 FILE: Shared\Administrative \Forms \Staff Forms \Employee Exp Reimb Request ,Gmail Receipt for Your Payment to pricemistake @gmail.com Pagel of 2 C a t J07:, o Ind G rl <ind r12000 Y Y Y9Y @9 rnaiI.com> b BETA Receipt for Your Payment to pricemistake @gmai9.com 1 message service @paypal.com <service @paypal.com> Fri, Mar 6, 2009 at 1:35 PM To: Katie Schneider <indygyrl2000 @gmail.com> PayPal Dear Katie Schneider, This email confirms that you have paid pricemistake Sign Up for a Free PayPal Account pricemistake @g mail.com $21.95 USD using PayPal. 0 100% protection for buyers against unauthorized account use This credit card transaction will appear on your bill as "PAYPAL 0 Your financial information is never `UNITEDSALE shared when you send a payment 0 Free for buyers Now that you've completed your payment, sign up for a free PayPal account by clicking Sign Up Now below. You'll be able to check out faster next time and track your payment history for all of the items you purchase on eBay. Sig Up Now! Payment Details Purchased From: pricemistake Receipt ID: 1375-6847-0860-9504 Item Item Title Quantity Price Subtotal' 250378356286 Casio Batte Charger for Exilim EX -Z70 1 $21.95 USD $21.95 USD EX -Z75 EX -Z77 Purchase r f� Shipping Handling via USPS Parcel Post to 462XX $0.00 USD Description (includes any seller handling fees) P.O. P or F Shipping Insurance (optional): G.L. t Toj k G' Total: $21.95 USD Budget Line Descr IaA �C4 Purchaser Da Approval Date Business information Business: pricemistake Contact E -Mail: pricemistake @g mail.com http: mail .google.com /mail ?ui =2 &ik =721 c75292e &view =pt &search inbox &th =11 fdd125... 3/6/2009 Gmail Receipt for Your Payment to pricemistake @gmail.com Page 2 of 2 Shipping Information Shipping Info: Mandy Spady 521 East 111 th St Indianapolis, IN 46280 United States Address status: Unconfirmed® Receipt Number: 1375 6847 0860 -9504 If you have been unable to resolve your questions with the merchant, PayPal offers a free buyer complaint resolution service that offers a quick, easy resolution to your concerns. It covers physical goods purchases made through PayPal, and is offered at no charge when you register for a free PayPal account. To sign up for an account, click on the 'Sign Up' link above. Keep your Receipt Number (shown above) for future reference. You will need to refer to this number if you need customer service from pricemistake or from PayPal. If you have questions about the shipping and tracking of your purchased item or service, please contact the seller pricemistake(cD Sincerely, PayPal Please do not reply to this email. Email sent to this address cannot be answered. PayPal Email ID PP847 http: /mail.google.com /mail ?ui =2 &ik =721 c75292e &view =pt &search inbox &th =11 fdd125... 3/6/2009 veriZRRnwireless Manage 777 BIG TIMBER ROAD Your Account Account Number Date Due ELGIN, IL 60123 M Verizon at www verizonvilireless 68101i073-00001 ovi5jw Invoice Number i 1989582430. I 10012155 01 AV 0.324 "AUTO T1 1 392046268 356511 12 E MICH2O10 Quick Bill Summary Feb 21- Mar 20 I IIIIIIIIIIII II III II III II IIIIIIII II III II III II III II III II III IIII KATIE A SCHNEIDER 3211 CHADWOOD LANE NORTH DR 1 A Previous Balance (see back for details) $135.88 INDIANAPOLIS, IN 46268-3565 Payment Thank You $135.88 Balance Forward $.00 Monthly Access Charges $90.97 Usage Charges Voice $89.10 Data $.00 Verizon Wireless' Surcharges and Other Charges Credits $5.68 Taxes, Governmental Surcharges Fees $8.38 Total Current Charges $194.13 Total Charges Due by April 15, 2009 $194.13 Purchase n Description �X P.O.# 2Porr,F G.L. L� Y DO 0 Lt J `I L (9 Budget Line Descr l, Purchaser ate_ L UM1 Approval D� 9 Pay from Wireless Pay on the Web Questions: m o VN ��vedZon wireless Bill Date March 20, 2009 Account Number 681011073 -00001 Invoice Number 1989582430 KATIE A SCHNEIDER Total Amount Due by April 15 2009 3211 CHADWOOD LANE NORTH DR 1A INDIANAPOLIS, IN 46268 -3565 Make check payable to s slip with Wireless $194.13 Plea return this remit slip payment El El F1 El El P.O. BOX 25505 LEHIGH VALLEY, PA 18002 -5505 L ��II11 II�IL,I II III II IIIJJI II III II����LI��I��I I F] Check here and fill out the back of this slip if your billing address has changed or you are adding or changing your email address. 19895824300106810110 ?3000010000194130000194139 ver® ®n wireiess Invoice Number Account Number Date Due Page r, Get Minutes Used Get Data Used Get Balance t► D A 3 e Explanation of Charges Payments Verizon Wireless' Surcharges Previous Balance $135.88 Verizon Wireless' Surcharges include charges to recover or help defray costs of taxes and of governmental charges and fees Payment Thank You imposed on us, including a Regulatory Charge (which helps defray Payment Received 02/27/09 135.88 costs of various regulatory mandates, including government number administration and license fees) and a Federal Universal Total Payments $135.88 Service Charge (and, if applicable, a State Universal Service Charge) to recover costs imposed on us by the government to Balance Forward $•00 support universal service, and may include other charges also related to our governmental costs. It also includes an Administrative Charge, which helps defray certain costs we incur, currently including (i) charges we, or our agerds, pay local telephone companies for delivering calls from our customers to their customers, (ii) fees and assessments on network facilities and services, and (iii) certain costs and charges associated with proceedings related to new cell site construction. Please note that these are Verizon Wireless charges, not taxes. These charges, and what's included, are subject to change from time to time. e Taxes, Governmental Surcharges and Fees Includes sales, excise and other taxes and governmental surcharges and fees that we are required by law to bill customers. These taxes, surcharges and fees may change from time to time without notice. Late Fee Information A late payment applies for unpaid balances. The charge is the greater of 1 0 5 or 1.5% pe or as permitted by !a... Verizon Wireless' Other Charges and Credits Includes charges for products and services, and credits owing. ii x Z fie sa v 0 Corre A ddress Verizon Wireless Operations Support P O Box�9058 *Dublin `OHt43017 Automatic Payment Enrollment for Account: 681011073-00001 KATIE A SCHNEIDER By signing below, you authorize Verizon Wireless to electronically debit your bank account each month for the total balance due on your account. The check you send will be used to setup Automatic Payment. You will be notified each month of the date and amount of the debit 10 days in advance of the payment. I understand and accept these terms. This agreement does not alter the terms of your existing Customer Agreement. I agree that Verizon Wireless is not liable for erroneous bill statements or incorrect debits to my account. To withdraw your authorization you must call Verizon Wireless. Check with your bank for any charges. 1. Check this box. 2. Sign name in box below, as shown on the bill and date. 3. Return this slip with your check for this month's payment. =M F] I I E Changing your billing address for Account: 681011073-00001 KATIE A SCHNEIDER Use this space or sign in to My Verizon at www.verizonwireless.com to change the mailing address where we send your bill. If we do not have your most recent email address, provide it below and we'll use it to tell you important information about your Verizon Wireless service. Allow 2 billing cycles for the address change to take effect. New Address PLACE OF PRIMARY USE (PPU) The home or business mailing address indicated to the left City is for the person using the phone(s) and is the person's State/Zip residential street address or primary business address _YES NO If 'NO" or for multi -line accounts with Daytime Phone Evening Phone more than one PPU address, please contact our Customer Service Department or visit our website to change the Email user's PPU address. Order 3920 Copy 10 Control #:10012155- 00036580 V.-�v ertLojj wireless Invoice Number Account Number Date Due Page T X1989582430° 68 =10,11073 00001 04/15109 3 ofT-4 r. tea'' �.".��s�L� .,s�.,:. r y ,u tau.. Summary for Katie a Schneider: 317 650 -9404 Your Calling Plan Charges Monthly Access Charges Nationwide Email &Messaging 450 Mins Unlim BlackBerry $99.991107 Current Calling Plan 03/21 04/20 99.99 $99.99 monthly access charge 15% Access discount 03/21 04/20 —15.00 450 monthly general allowance minutes WPP Insurance Asurion 03/21 04/20 4.99 $.45 per minute after allowance Ringback Tones —03/21 04/20 .99 $90.97 Unl Night Weekend Min Unlimited OFFPEAK Usage Charges Voice 89.10 Unl Text Messaging Data .00 Unlimited M2M TXT $8910 Unlimited TXT Message Verizon Wireless' Surcharges BlackBerry EVDO for MB Fed Universal Service Charge 2.46 Unlimited monthly megabyte Regulatory Charge .07 Administrative Charge .85 Beginning on 06/21/07: IN Utility Receipts Surcharge 1.58 15% Access discount IN Telecom Relay Surcharge .03 M2M National Unlimited IN Universal Service Fee .60 Unlimited monthly Mobile to Mobile IN State PUC Fee .09 $5.68 Unl Picture/Video MSG Taxes, Governmental Surcharges and Fees Unlimited monthly PIX —FLIX IN State E911 Fee .50 IN State Sales Tax 7.88 $8.38 Total Current Charges for 317 650 -9404 $194.13 Usage Charges Voice Allowance Used I Billable I Cost Calling Plan minutes 450 648 198 89.10 Mobile to Mobile minutes unlimited 350 Night/Weekend minutes 224 Total Voice $89.10 Data 0 Unbilled Usage from Previous Months 0 Megabyte Usage megabytes 1 N N Current Data Usage s TXT Messaging messages unlimited 998 Unlimited M2M TXT messages unlimited 287 0 PIX —FLIX Messaging messages unlimited 9 Megabyte Usage megabytes unlimited 4 Total Data $.00 a Total Usage Charges $89.10 0 N m M h View your bill and call details online for FREE. Sign in to My Verizon at www.verizonwireless.com, 0 V�erizonwireless Invoice Number Account Number Date Due Page Need —to —Know Information Limiting Notations on Payments Written notations included with or on your payment cannot be reviewed when bills are processed and will not be honored. Please send such notated payment and any accompanying correspondence to the Correspondence Address on Page 2 of your bill. Electronic Fund Transfer (EFT) Your check authorizes us either to make a one —time electronic funds transfer (EFT) from your account or process as a check. An EFT may be withdrawn from your account the same day you make your payment and your check is not returned to you. If you want to be excluded from EFT, please call 1- 866 544 -0401. If payment is returned unpaid, you authorized us to collect an additional $25 fee through EFT from your account. Picture and Video Messaging Pricing Change Effective 05103/09, when you send a picture or video message to multiple recipients, you will be charged once for each recipient. If you already have a messaging bundle, these messages will apply towards your bundle quota. If you are on a Pay —as —You go plan or exceed your bundle quota, you will be charged $.25 per recipient. Backup Assistant(SM) Never lose your contacts again! Backup Assistant automatically backs up your address book wirelessly for just $1.99 per month, per line. But, we'll waive the monthly fee for customers who register for My Verizon online. Visit www.vedzonwireless .com/backupassistant for details. Ringtones Ringback Tones Have fun with your phone. With Ringtones and Ringback Tones, you and your callers can enjoy hot new songs, or "classics" from the past, whenever a call comes in. Choose from thousands of songs to personalize your rings. Go to www.verizonwireless.com /mediastore for charges and details. Voice Mail is required for use of Ringback Tones. 0 0 0 N_ O O_ it O O U 0 a 0 U 0 N O A m aS veriZ ni iretess 777 BIG TIMBER ROAD Manage Your Account Account Number Date Due ELGIN, IL 60123 68 01 03/15/09 Invoice Number 1 1976474683 10011968 01 AV 0.324 "AUTO T81 382046268- 356511 12 E MICH2O10 Quick Bill Summary Jan 21 Feb 20 I I I I 1 1111111111 11 111 11 111 I I I I I I I I I I I I I I I I 1 I I KATIE A SCHNEIDER 3211 CHADWOOD LANE NORTH DR 1 A Previous Balance (see back for details) $101.07 INDIANAPOLIS, IN 46268 -3565 Payment Thank You $101.07 Balance Forward $.00 Monthly Access Charges $90.97 Usage Charges Voice $35.83 Data $.00 Verizon Wireless' Surcharges and Other Charges Credits $3.72 Taxes, Governmental Surcharges Fees $5.36 3 Total Current Charges $135.88 Add a line to your account It's easy! It's a great time to add a line to your Total Charges Due by March 15, 2009 $135.88 account. We have a lot of cool phones and features for the entire family, along with all- inclusive Calling Plans. Plus, the Purchase network reliability you need. Call Description 1- 866 745 -4662 today! P.O. or F G. L _t C 1 4 '3 9 1 Budget Line Descx Purchaser Date Approval Date_ l Pay from Wireless Pay on the Web Questions: #PM! (#768) My Verizon 20 rom your. wire ess VN \.,�veriznwir Bill Date February 20, 2009 Account Number 681011073 -00001 Invoice Number 1976474683 KATIE A SCHNEIDER Total Amount Due by March 15, 2009 3211 CHADWOOD LANE NORTH DR 1A INDIANAPOLIS, IN 46268 -3565 Make check payable to Verizon Wireless $1 35.88 Please return this remit slip with payment $1111❑■ P.O. BOX 25505 LEHIGH VALLEY, PA 18002 -5505 I11�IILILII�I�IL�11II1111�LILI1111�1�I ,L1L111 F] Check here and fill out the back of this slip if your billing address has changed or you are adding or changing your email address. 1 97647468301068101107300001 ,0000135880000135889 veer wireless Invoice Number Account Number Date Due Page 1976474683 681011Q73 0000103115/09 x '2 of 4 Get Minutes Used Get Data Used Get Balance SEND DA A e Explanation of Charges Payments Verizon Wireless' Surcharges Previous Balance $101 .07 Verizon Wireless' Surcharges include charges to recover or help defray costs of taxes and of governmental charges and fees Payment Thank You imposed on us, including a Regulatory Charge (which helps defray P ayment Received 02/03/09 101.07 costs of various regulatory mandates, including government number administration and license tees) and a Federal Universal Total Payments $101.07 Service Charge (and, if applicable, a State Universal Service Balance Forward .00 Charge) to recover costs imposed on us by the government to support universal service, and may include other charges also related to our governmental costs. 11 also includes an Administrative Charge, which helps defray certain costs we incur, currently including (i) charges we, or our agents, pay local telephone companies for delivering calls from our customers to their customers, (ii) fees and assessments on network facilities and services, and (iii) certain costs and charges associated with proceedings related to new cell site construction. Please note e that these are Verizon Wireless charges, not taxes. These charges, and what's included, are subject to change from time to time. 0 Taxes, Governmental Surcharges and Fees Includes sales, excise and other taxes and governmental surcharges and fees that we are required by law to bill customers. These taxes, surcharges and fees may change from time to time without notice. Late Fee Information A late payment applies for unpaid balances. The charge is the greater of $5 or 1.5% per month, or as permitted by law. Verizon Wireless' Other Charges and Credits Includes charges for products and services, and credits owing: Via' ---b- Correspondence A Wlreless�Operatlons�S "P 0 Box 9058 Dub11n,TOH'4301 Automatic Payment Enrollment for Account: 681011073 -00001 KATIE A SCHNEIDER By signing below, you authorize Verizon Wireless to electronically debit your bank account each month for the total balance due on your account. The check you send will be used to setup Automatic Payment. You will be notified each month of the date and amount of the debit 10 days in advance of the payment. I understand and accept these terms. This agreement does not alter the terms of your existing Customer Agreement. I agree that Verizon Wireless is not liable for erroneous bill statements or incorrect debits to my account. To withdraw your authorization you must call Verizon Wireless. Check with your bank for any charges. 1. Check this box. 2. Sign name in box below, as shown on the bill and date. 3. Return this slip with your check for this month's payment. Changing your billing address for Account: 681011073 -00001 KATIE A SCHNEIDER Use this space or sign in to My Verizon at www.verizonwireless.com to change the mailing address where we send your bill. If we do not have your most recent email address, provide it below and we'll use it to tell you important information about your Verizon Wireless service. Allow 2 billing cycles for the address change to take effect. New Address PLACE OF PRIMARY USE (PPU) The home or business mailing address indicated to the left city is for the person using the phone(s) and is the person's State/Zip residential street address or primary business address —YES—NO If "NO" or for multi -line accounts with Daytime Phone Evening Phone more than one PPU address, please contact our Customer Service Department or visit our website to change the Email user's PPU address. Order 3820 Copy 10 Control #10011968- 00036098 V,--�ved 1. Invoice Number Account Number Date Due Page Summary for Katie a Schneider: 317 650 -9404 Your Calling Plan Charges Monthly Access Charges Nationwide Email &Messaging 450 Mins Unlim BlackBerry $99.991107 Current Calling Plan 02/21 03/20 99.99 $99.99 monthly access charge 15% Access discount 02/21 03/20 —15.00 450 monthly general allowance minutes WPP Insurance Asurion 02/21 03/20 4.99 $.45 per minute after allowance Ringback Tones —02/21 03/20 .99 $90.97 Unl Night Weekend Min Unlimited OFFPEAK Usage Charges Voice 35.83 Unl Text Messaging Data .00 Unlimited IN TXT $35.83 Unlimited TXT Message Verizon Wireless' Surcharges BlackBerry EVDO for MB Fed Universal Service Charge 1.38 Unlimited monthly megabyte Regulatory Charge .07 Administrative Charge .85 Beginning on 06/21/07: IN Utility Receipts Surcharge .97 15% Access discount IN Telecom Relay Surcharge .03 M2M National Unlimited IN Universal Service Fee .37 Unlimited monthly Mobile to Mobile IN State PUC Fee .05 $3.72 Unl Picture/Video MSG Taxes, Governmental Surcharges and Fees Unlimited monthly PIX —FLIX IN State E911 Fee .50 IN State Sales Tax 4.86 $5.36 Total Current Charges for 317 650 -9404 $135.88 Usage Charges Voice Allowance Used Billable Cost Calling Plan minutes 450 1 523 1 73 32.85 Mobile to Mobile minutes unlimited 401 Night/Weekend minutes 128 411 Search calls 2 r 2 2.98 Total Voice $35.83 0 Data 0 TXT Messaging messages unlimited 1368 Unlimited IN TXT messages unlimited 268 0 PIX —FLIX Messaging messages unlimited 11 R Ringback Tones items 1 1 0 Megabyte Usage megabytes unlimited 7 Total Data $.00 Total Usage Charges $35.83 0 0 U 0 N View your bill and call details online for FREE. Sign in to My Verizon at www.verizonwireless.com. 0 �vedzonwireless Invoice Number Account Number Date Due Page 1976474683 681011073`00001 03%15/09 4 of 4 Need —to —Know Information a i_iiniting Notations on Payments Written notations included with or on your payment cannot be reviewed when bills are processed and will not be honored. Please send such notated payment and any accompanying correspondence to the Correspondence Address on Page 2 of your bill. s Electronic Fund Transfer (EFT) Your check authorizes us either to make a one —time electronic funds transfer (EFT) from your account or process as a check. An EFT may be withdrawn from your account the same day you make your payment and your check is not returned to you. If you want to be excluded from EFT, please call 1- 866 544 -0401. If payment is returned unpaid, you authorized us to collect an additional $25 fee through EFT from your account. Great News Connect with more people than ever before! Effective immediately, you will be able to connect with 80 Million Verizon Wireless customers at any time of the day without using your plan minutes or your message allowances. All Verizon Wireless customers with IN Calling (Mobile to Mobile) or IN Messaging will automatically be able to enjoy America's largest mobile to mobile calling messaging family. To learn more, visit us on the web at wvvw.vzw.com /in. BroadbandAccess changes name to Mobile Broadband Our customers have asked for product names that are direct and more easily understood. We listened to the feedback and, as a result, we are changing the name of our "Broad bandAccess" service to "Mobile Broadband Because this is simply a name change, you will still enjoy the same quality service including convenient Internet on the go at 3G speeds. During the transition period you may still see the name "BroadbandAccess" appear from time to time. "IN" changes name to "Mobile to Mobile" Our customers asked for product names that are direct and more easily understood. We have listened to the feedback and, as a result, we are changing the name of our "IN Calling" and "IN Messaging" services to "Mobile to Mobile Calling" and "Mobile to Mobile Messaging Because this is just a name change, if you currently enjoy IN Calling service, you will still enjoy the same benefit of connecting with more than 80 million Verizon Wireless customers any time of the day without using up any of your plan minutes. During the transition period you may still see the name "IN Calling" and "IN Messaging" appear from time to time. Get GPS on Your Phone with VZ Navigator(SM) m Get spoken turn —by —turn directions to any U.S. address right from your phone with VZ Navigator. Use the local search feature to find one of 14 million local businesses and attractions, including restaurants, ATMs, shopping and more. VZ Navigator also includes other tools.you can use everyday, like traffic info, gas stations prices, movie times, weather and local events. Just $9.99 per month or $2.99 per day (24 hours use). Go to www. verizonwireless.com /vznavigator for details. Save Money with Messaging Bundle Get Unlimited Messaging to other Verizon Wireless customers, plus additional Messages to other users for only $10 /month per line. Call 1- 866 745 -4662 for more details and to sign up. m o` 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. 359185 Schneider, Kate Terms 3211 Chadwood Lane N. Drive, 1A Indianapolis, IN 46268 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 2/20/09 Reimb. Cell phone fees 50.00 3/20/09 Reimb. Cell phone fees 50.00 3/6/09 Reimb. Battery charger for office camera 21.95 3/31/09 Reimb. Mgr retreat lunches 157.32 4/1/09 Reimb. Guest services lunch 19.59 3/30/09 Reimb. Ship handhelds back to Vermont Systems 10.95 4/1/09 Reimb. Consultant lunch 37.67 Total 347.48 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 1 20 Clerk- Treasurer Voucher No. Warrant No. 359185 Schneider, Kate Allowed 20 3211 Chadwood Lane N. Drive, 1A Indianapolis, IN 46268 In Sum of 347.48 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund 104 Program Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1047 Reimb. 4344100 50.00 1 hereby certify that the attached invoice(s), or 1047 Reimb. 4344100 50.00 bill(s) is (are) true and correct and that the 1047 Reimb. 4230200 21.95 materials or services itemized thereon for 1047 Reimb. 4341993 157.32 which charge is made were ordered and 1047 Reimb. 4341993 19.59 received except 1125 Reimb. 4342100 10.95 1047 Reimb. 4341993 37.67, 8 -Apr 2009 Signature 347.48 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund