HomeMy WebLinkAbout175166 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 362215 Page 1 of 1
0 ONE CIVIC SQUARE BROOKE TAFLINGER
CARMEL, INDIANA 46032 11008 BROADWAY ST CHECK AMOUNT: $15.00
•c,. INDPL.S IN 46280 CHECK NUMBER: 175166
CHECK DATE: 7/22/2009
DEPARTMEN A CCOUNT PO NUMBER INVOICE NU AMOUNT DESCRIPTION
1047 4343004 REIMB 15.00 TRAVEL PER DIEMS
Carmel Clay
Parks &Rec reation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
('PAR KS TE.PIf. VAN
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL:
Employee Name (print) &�M JUN 24 2009
Address
Check
payable to: City, St, Zip A� p�
Signature: Approved by:
Date: 1 Date: f s/69
Business Services Division, Revised 7 -7 -08
FILE: Shared \Administrative\Forms\Staff Forms\Employee Exp Reimb Request
WELCOME
Ricker's #26
3240 N. Executive
Yorktown, IN 47396
6984660
RICKERS #26
3240 EICUTIUE PART(
YORKTOWN IN
TRAN 10901431 PUM
DATE 06/08/09 16 :45 Dmdp#M
PUMP 09 PwF l�
P.O. A
PRODUCT: UNI_ OI.A q
GALLONS: 5.174 Budget
PRICE /G: 2.849 UneDes.
FUEL. SALE 15.00 Pu 0{
ApP rond
Payment from
Primary Account
xxxxxxxxxxxx
Auth
Ref: 441002
Resp Code: 000
Stan: 1003965419
Trace 00031939
SITE ID: 6984660
THANK YOU
HAVE A NICE DAY
ACCOUNTS PAYABLE VOUCHER
d 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.
362215 Taflinger, Brooke Terms
11008 Broadway Ave
Indianapolis, IN 46280
i
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/8/09 Reimb. Fuel for Parks Dept. van 15.00
Total 15.00
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
r
Voucher No. Warrant No.
362215 Taflinger, Brooke Allowed 20
11008 Broadway Ave
Indianapolis, IN 46280
In Sum of
15.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #1TITLE AMOUNT Board Members
Dept
1047 Reimb. 4343004 15.00 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
14 -Jul 2009
Signature
Is 15.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund