HomeMy WebLinkAbout213374 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 360484 Page 1 of 1
' ONE CIVIC SQUARE AMY BALDAUF
0 ti' CHECK AMOUNT: $57.16
CARMEL, INDIANA 46032 APT D LARK DR
o„ CHECK NUMBER: 213374
CARMEL IN 46032
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 57 . 16 GENERAL PROGRAM SUPPL
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Carmel ® Clay (acr," 0- -�yle-svn
Parks&Recreation
Employee Expense Reimbursement Request
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Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
All receipts should be attached in the same order as listed above. r
No sales tax will be reimbursed. TOTAL:
Employeen Name(print) Pav-i 33 koo—' -
Address (-2-(P.- L t \
Check
payable to: City, St, Zip Came-
Signature: Approved by:
Date: C� � l Z Date:Revised 3-2-07 3-2-07 by Business Services;
Shared/Forms and Templates/Business Service Forms/Employee,Exp Reimb Request 2007-3
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ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly f hours, rate perhhourknumbe where performed,
per nit a dates service rendered, by
whom, rates per day, numbs
Payee Purchase Order No.
Terms
360484 Baldauf, Amy Date Due
126 Lark Dr., Apt. D
Carmel, IN 46032
Invoice Invoice Description PO# Amount
note attached invoice(s) or bill(s))
Date Number (or $ 57.16
9/17/12 Reimb Supplies
Milea a 12/1/09 -4/27/10
Total $ 57.16
ls)is(are)true and correct and I have audited same in accordance
I hereby certify that the attached invoice(s),or bil
with IC 5-11-10-1.6
20_
Clerk-Treasurer
i
Voucher No. Warrant No.
360484 Baldauf, Amy Allowed 20
126 Lark Dr., Apt. D
Carmel, IN 46032
In Sum of$
$ 57.16
ON ACCOUNT OF APPROPRIATION FOR _
108 - ESE
PO#or INVOICE NO. ACCT#iTITLE AMOUNT Board Members
Dept#
1081-8 Reimb 4239039 $ 57.16 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
4-Oct 2012
_
11&h&mfiw -
Signature
$ 57.16 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund