HomeMy WebLinkAbout217950 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 360484 Page 1 of 1
ONE CIVIC SQUARE AMY BALDAUF
CARMEL, INDIANA 46032 126 LARK DR CHECK AMOUNT: $91.22
APT D
CHECK NUMBER: 217950
CARMEL IN 46032
CHECK DATE: 3/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 REIMB 91 . 22 GENERAL PROGRAM SUPPL
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Your Code: 7ll�'33ll-0l8l-hD58
SUrV�� should be completed within T2 l'i[G
14490 Clay T(--!r[mC8 BlA
Carmel' IN 46092
317-580-0765
1-0St: C8Sh UZ/23/%Ul3
TNll'HI ll ::::4 AM
10097
CHICKEN LRG 13.29
, STEAK LRG 15.99
CHIPO, SIDE (5 @O.99) 4.95
C41 X-TORTILLA3 6,00
~—CAT CH[E3E - §��}�
'AT LETTUCE §.0O
RICE LRG (2 @14.99) 9.98
BLACK MEANS LRG 5.9]
QUEqO LRG ll .29
CHZ&3R CRN 1,15 C40.69) 3.211")
0} SALSA 1(12 (K.59) 8.28
Sub�O1ul 9l .22
TdY Exempt #0119683083 0.,GO
Tax O.OV
7O GO Total 91 .22
91 '22
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REter to oto[8 # 230
Carmel e Clay
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
24Z3j 1 0 - 42-S90 Gee e/a,l VrQalap 0-( j, ZZ StCA-Cf f-rdf7/-f
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $ Z-Z-
Employeen Name(print) Aw y E- (da u+
C >��TI�
t FEB 2 6 2013
Address �� l n,.� Q Y,
Check BLi
payable to: City, St, Zip --
Signature: Approved by:
Date: L2 Date:
Revised 3-2-07 by Business Services;
Shared/Fors and Templates/Business Service Fors/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.
360484 Baldauf, Amy Terms
126 Lark Dr., Apt. D Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
2/23/13 Reimb Qdoba for Staff training $ 91.22
Mileage 12/1/09 -4/27/10
Total $ 91.22
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
i
Voucher No. Warrant No.
360484 Baldauf, Amy Allowed 20
126 Lark Dr., Apt. D
Carmel, IN 46032
In Sum of$
$ 91.22
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-8 Reimb 4239039 $ 91.22 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-Mar 2013
&7
hff/M- "/P
Signature
$ 91.22 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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