216157 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 366298 Page 1 of 1
ONE CIVIC SQUARE TRACI PETTIGREW
0 CHECK AMOUNT: $140.87
CARMEL, INDIANA 46032 cio MCC
CHECK NUMBER: 216157
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 140 . 87 GENERAL PROGRAM SUPPL
Carmel ® Clay
Parks&Recreati®n
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
TY'e2 PxUI a�-o`z�bon
All receipts should be attached in the same order as listed above. �1
No sales tax will be reimbursed. TOTAL:
Employee Name(print)
Address
11-3, 15 CcrItYO..I IZT. - IDr- Ea St DEC 21 2
Check 01Z
payable to: City, St, Zip rVY 6 1N �4kon2
Y p C� � 1 �-t--_
Signature: Approved by:
lR
Date: Date:
Business Services Division,Revised 7-7-08
FILE: Shared\Administrative\Forms\Staff Forms\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.
366298 Pettigrew, Traci Terms
1503 White Ash Dr.
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
12/20/12 Reimb Program supplies $ 140.87
Total $ 140.87
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.
366298 Pettigrew, Traci Allowed 20
1503 White Ash Dr.
Carmel, IN 46033
In Sum of$
$ 140.87
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-60 Reimb 4239039 $ 140.87 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
3-Jan 2013
Signature
$ 140.87 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund