217067 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
`• ONE CIVIC SQUARE TIFFANY BUCKINGHAM
s
CARMEL, INDIANA 46032 5057E 71ST STREET CHECK AMOUNT: $15.00
INDIANAPOLIS IN 46205 CHECK NUMBER: 217067
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 15 . 00 GENERAL PROGRAM SUPPL
ck
®Ol[AR TREE STORES INC..
Store# 2092 - 1. (317) 255-8611
7225 North Keystone Ave
Suite D
Indianapolis IN 46240-3291
DESCRIPTION . QTY PRICE TOTAL
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DISHPAN 80T 1 1.00 1.00N
DISHPAN 80T 1 1.00 1.00N
DISHPAN 80T 1 1.00 L OON
DISHPAN 80T 1 1.00 1.00N
DISHPAN 80T 1 1.00 1.00N'
DISHPAN 80T 1 1.00, 1.00N
DISHPAN 80T 1 1.00 L OON
DISHPAN 80T 1 1.00 1.00N
DISHPAN 80T 1 1.00 1.00N
DISHPAN 80T 1 1.00 1.00N
DISHPAN 80T 1 1.00 1.00N
DISHPAN 80T 1 1.00 1.00N°
DISHPAN 80T 1 1.00 1.00N
DISHPAN 80T 1 1.00 1.00N'
DISHPAN 8OT 1 1.00 1.00N
Sub Total $15.00
SALES TAX $0.00
Total $15.00
K
Auth/Trace Number: 068019/00406462
**** Tax Exempt ****
ID #: 0119683083
SALE
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Thank You for Shopping at Dollar Tree
Where Everything's $1.00
Now Shop On-Line at Dollartree.com
8285 02092 04 041 30798 1/17/13 12:07
Sales Associate:Lvdicia
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
CO` '`I sW�'
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: Is 1 rj . l� .v- _--- —
Employeen Name(print) 1 (�V1�1 �JC 1 >1(n�(Y�Y� JAN 2 4 2 013
Address ✓lJ�� I St ' '-�---
Check \\ , ff �L°
payable to: City, St,Zipl n(\ aY1 Gl(x(71 k J I N �LDZZO
Signature: \ Approved by:
Date: ��t�Q �� Date: I ?�
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.
358408 Buckingham, Tiffany Terms
5057 E 71 st St
Indianapolis, IN 46205
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
1/16/13 Reimb. Dollar Tree supplies $ 15.00
Mileage 9/12 - 11/12/12
Total $ 15.00
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.
358408 Buckingham, Tiffany Allowed 20
5057 E 71st St
Indianapolis, IN 46205
In Sum of$
$ 15.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-2 Reimb. 4239039 $ 15.00 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
7-Feb 2013
Signature
$ 15.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund