HomeMy WebLinkAbout212147 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
ONE CIVIC SQUARE TIFFANY BUCKINGHAM
CARMEL, INDIANA 46032 5130 PRIMROSE AVE
CHECK AMOUNT: $137.95
INDIANAPOLIS IN 46205 CHECK NUMBER: 212147
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 137 . 95 GENERAL PROGRAM SUPPL
1021-2-q 2:Y1 Cl
C � 1 panatm Sven I,Ps
Einstein Bros Bagels
Store # 2683 PH: (317) 577-9888
8/13/2012 7:14:23 AM ._#
Order Number: 2069800
Take J Out
Cashier: Josh -�_ r
Register: 2 to—1 ((1 (\Vlf1C�4c5vyvl
4 Hate To Wait 58.000
5 Darn Good 79.95
Sub. Total : 137.95
Tax: 0.00
Total : 137.95
Discount Total : 0.00
Change 0.00
Visa: -137.95
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PLU:
Validation Code:
Visa
Card Num : XXXXXXXXXXXX3441
Terminal : 1L18909420001
Approval : 441972
Sequence : 060817
I agree to pay the above Total Amount
according to Card Issuer Agreement.
Signature:
Carmel ® Clay
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
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IV- e-Oa 0215
All receipts should be attached in the same order as listed above. tt _
No sales tax will be reimbursed. I TOTAL: Is l
Employeen Name(print) 4VkV\y 0Q.(h ilcibQ w\,
Address st-
Check
payable to: City, St, Zip I t
ham-ti✓t of a n t s )1\3 q(D u O
Signature: ` Approved by:
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.
Terms
358408 Buckingham, Tiffany
5130 Primrose Ave
Indianapolis, IN 46205
Invoice Invoice Description Amount
or note attached invoice(s) or bill(s)) PO#
Date Number ( $ 137.95
8/13/12 Reimb. Supplies
W; M
Total $ 137.95
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
Voucher No. Warrant No.
358408 Buckingham, Tiffany Allowed 20
5130 Primrose Ave
Indianapolis, IN 46205
In Sum of$
$ 137.95
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-2 Reimb. 4239039 $ 137.95 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
23-Aug 2012
Signature
$ 137.95 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle'highway fund