219255 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 360144 Page 1 of 1
` ONE CIVIC SQUARE CYNTHIA CANADA
CHECK AMOUNT: $50.13
�.J CARMEL, INDIANA 46032 11508 LUCKY DAN DRIVE
o� NOBLESVILLE IN 46060 CHECK NUMBER: 219255
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 924294510 50 . 13 TRAVEL FEES & EXPENSE
ark` I .4 Clay
parks&Rec�reati.on
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
`-f � I� S'�Gr c k.s It�X,-�I e eSSe -- V
t c.Cl Z Z l
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $5 s
Employeen Name(print) C\'A. i Cc'-, Pv--- :=�—
Address L(A ICU ('-�,-n L r .
Check f
payable to: City, St, Zip '(y `p U �� —q(ON oD
Signature: ct - - Approved by: �f r
Date: y 1 tr GJ I Date:
Revised 3-2-07 by Business Services;
Shared/Forms and Templates/Business Service Forms/Employee Exp Reimb Request 2007-3
SALE
OMNI SEVERIN HOTEL
LA PIEDAD MEXICAN RESTAUR
6524 N CORNELL AVE INDIANAPOLIS , IN 46225
INDIANAPOLIS, IN 46220 S T A R B U , K S
317-475-0988
x 522 CRYSTAL
p MERCHANT ID: XXXXXXX50134204 -
p DEVICE ID: 2808 I
Item: 053 MC SALE i SWIPED C H K 1 9 0 1 APR 0 8 13 6 : 4 8 A M
Acct; VWVXXXXX8014 - -- - - -- - - -- - ----- ----- --- ----- --
__.
INVOICE: 2053
153 S, Illinois SERVER ID: 2 2 V COFFEE 5 , 10
Indianapolis, IN 46225 1 TURKEY BACON SAN 3 . 95
317-635-9594 FOOD�BEV/TAX 1 SPINACH WRAP 3 . 95
harryandizzys.com $ 22.8$
SUBTOTAL 13 . 00
62162 Tasha P
TIP $-----'-- TAX 1 . 17 PAYMENT 14 , 17
lbl 152/4 Chk 4165 Gst 1 a I XXXXXXXXXXXX2238
AprO9'13 12:38PM TOTAL $ —__ X X 2 2 5 3
"-------------------- I AGREE TO PAY ABOVE AMOUNT ACCORDING B a 1 : 0 , 00
1 BBQ Ch i ckrl Pizza 12.00 TO CARD ISSUER AGREEMENT S B G C REDEEM 0 .91
(MERCHANT AGREEMENT IF RETURN)
XXXXXXXXXXXX8083
Subtotal 112,00 THANK YOU � X X 16 12
Tax 1 08 www.laaiedadlndv.com B a t ; 0 , 00
C 1 :08PM Total 13 08 i DATE: 04/08/13 TIME: 18:57 S B GC REDEEM 1 0 . 00
RESP: AUTH/TWT 412916 XXXXXXXXXXX;(9837
TID: NDGGL84580408 ACI:
XX4206
BOTTOM COPY-CUSTOMER B a t : 3 , 8 8
SB GC REDEEM 3 , 26
AfTer Scnooi
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Cndi Canada
Cgrmei Clay Parks _
& Recreation
"r Carmei, IN
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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.
360144 Canada, Cyndi Terms
11508 Lucky Dan Dr :
Noblesville, IN 46060
Ik
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
4/15/13 Reimb NAA Conference expenses $ 50.13
Mileage 9/25-12/28/12
Total $ 50.13
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
Voucher No. Warrant No.
360144 Canada, Cyndi Allowed 20
11508 Lucky Dan Dr
Noblesville, IN 46060
In Sum of$
$ 50.13
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 Reimb 4343000 $ 50.13 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
18-Apr 2013
Signature
$ 50.13 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund