213547 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 362613 Page 1 of 1
ONE CIVIC SQUARE LINDSAY LEBER
CARMEL, INDIANA 46032 CHECK AMOUNT: $8.00
CHECK NUMBER: 213547
CHECK DATE: 10/912012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4231400 8 . 00 GASOLINE
C
Carmel • Clay
F ��Vr 7-7 Parks&Recreation EP 2 4 %012
Employee Expense Reimbursement Request BY: _ _.
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
1 1 ocitnatn 1-0 COr1Q
CCCPR vehicle
All receipts should be attached in the same order as listed above. dp
No sales tax will be reimbursed. TOTAL:
Employee Name(print) LAV' SoLu t Alt*-
Address ' "l Q L4 1 1(1 n ear Dr
Check
payable to: City, St, Zip1'�j
Signature: Approved by:
Date: /(� Date:
Business Services Division,Revised 7-7-08
FILE: Shared\Forms\Business Services\Employee Exp Reimb Request
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.
362613 Leber, Lindsay Terms
11904 Igneous Dr
Fishers, IN 46038
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
9115112 Reimb. Fuel for CCPR vehicle $ 8.00
Total $ 8.00
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.
362613 Leber, Lindsay Allowed 20
11904 Igneous Dr
Fishers, IN 46038
In Sum of$
$ 8.00
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
I
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 Reimb. 4231400 $ 8.00 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
AS&MVil Z
Signature
$ 8.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund