HomeMy WebLinkAbout210400 07/05/2012 CITY OF CARMEL, INDIANA VENDOR: 366341 Page 1 of 1
ONE CIVIC SQUARE BRADLEY HOLSTEN
CARMEL, INDIANA 46032 C/O ESE CHECK AMOUNT: $51.90
CHECK NUMBER: 210400
CHECK DATE: 715/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4239039 REIMB 51.90 GENERAL PROGRAM SUPPL
Carmel Clay
Parks &Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Ve ndor listed on receipt Line Budget Description Amount Purpose of Expense
tL 1ti4x 0-5, i�4�2 4z3 q
tA I�n 3 g� (n�Z 3 42:5103 11 -0 zjC
All receipts should be attached in the same order as listed above. CID
No sales tax will be reimbursed. TOTAL: �j
Employeen Name (print) U o -r N Gu -1 �n>>� �qr�1
I n JUN 1 1 2912
Address 4-55'3 J> a w il 41 !�;zi C
Check
payable to: City, St, Zip
Signatu Approve
Date: Date:
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.
Holsten, Bradley Terms
4532 Bevington Ln Apt C Date Due
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/6/12 Reimb. Supplies 51.90
Total 51.90
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
1 20
Clerk- Treasurer
1
Voucher No. Warrant No.
Holsten, Bradley Allowed 20
4532 Bevington Ln Apt C
Indianapolis, IN 46240
In Sum of
51.90
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept
1082 -3 Reimb. 4239039 51.90 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
28 -Jun 2012
Signature
51.90 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund