209759 06/18/2012 CITY OF CARMEL, INDIANA VENDOR: 363065 Page 1 of 1
ONE CIVIC SQUARE JAMES DOWELL CHECK AMOUNT: $164.28
CARMEL, INDIANA 46032 C/O PARKS ESE
CHECK NUMBER: 209759
CHECK DATE: 6/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 164.28 GENERAL PROGRAM SUPPL
Carmel Clay
Parks &Recr eato ®n
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense
31 411 nS1 �3903i 6 i e 5 33-
v C ubJ v es
kornC off- �0�� _3 ya3�o3�t 5v s 130, b i
All receipts should be attached in the same order as listed above. rr��
No sales tax will be reimbursed. TOTAL: I �j J OC
Employeen Name (print) C➢ (�C� p I' C+ I� j
Address 9 S53 ro F r 61 MAY 3 0 2012
Check
payable to: City, St, Zip k y L l6Ztl o
Signature: Approved by: i
Date: O` 1 Date: f Z
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.
363065 Dowell, James Terms
9353 Barcroft Dr, Apt A
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5121112 Reimb. Supplies 164.28
Mileage 10/17/11 4/12/12
Total 164.28
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.
363065 Dowell, James Allowed 20
9353 Barcroft Dr, Apt A
Indianapolis, IN 46240
N&W P.DDRLSS In Sum of
164.28
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept
1081 -3 Reimb. 4239039 164.28 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 -Jun 2012
Signature
164.28 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund