HomeMy WebLinkAbout180195 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 362749 Page 1 of 1
ONE CIVIC SQUARE KELSEY MILLER
i CHECK AMOUNT: $179.59
CARMEL, INDIANA 46032 13259 EASTWOOD LN
FISHERS IN 46038 CHECK NUMBER: 180195
CHECK DATE: 1218/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4230200 REIMB 25.00 OFFICE SUPPLIES
1046 4239037 REIMB 15.59 CLUB ACTIVITY SUPPLIE
1046 4239038 REIMB 139.00 AWARDS PRIZES
Carmel Clay
Park &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Ex ense
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All receipts should be attached in the same order as listed above.
N s al es t ax will be reimbursed. TOTAL: l
Employee dame (print) K e I See
Address
Check
payable to: City, St, Zip 1 0 QX
Signatur �r Approved by:
Date: aC) Date:
nusiness Services Division, Revised 7 -7 -08
FILL=: SharedlAdministrativelFormsk $ta$ FormslEmployee Exp Reimb Request
NOV 0 1009 1
D 'Y 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.
Terms
362749 Miller, Kelsey
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
25.00
11119109 Reimb. Office supplies MT 15 59
11/19709 Reimb. Club supplies MT 139.00
11/19/09 Reimb. Awards Prizes MT
Total 179.59
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
Vouches No. Warrant No.
362749 Miller, Kelsey Allowed 20
In Sum of
179.59
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or Board Members
Dept INVOICE NO. ACCT 4/TITLE AMOUNT
1046 Reimb. 4230200 25.00 1 hereby certify that the attached invoice(s), or
1046 Reimb. 4239037 15.59 bill(s) is (are) true and correct and that the
1046 Reimb. 4239038. 139.00 materials or services itemized thereon for
which charge is made were ordered and
received except
3 -Dec 2009
Signature
179.59 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund