219728 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 367058 Page 1 of 1
0 ONE CIVIC SQUARE BRADLEY GENTRY CHECK AMOUNT: $128.85
CARMEL, INDIANA 46032 3658 CRICKWOOD DRIVE
INDIANAPOLIS IN 46268 CHECK NUMBER: 219728
CHECK DATE: 5/7/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 83 . 62 TRAVEL PER DIEMS
1207 4239040 TIP 45 . 23 FOOD & BEVERAGES
Brookshire Golf Club
Carmel, Indiana
Substitute Form 4070A
Employee's Daily Record of Tips
Employee Name (please print) ! eAacc-1 bEN'Rz"� Payroll #
Day Date Total Tips Received
I
Saturday 13 116-.z3
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Total Weekly Tips
Substitute Form 4070
Employee's Report of Tips to Employer
Employee's Name and Address Employee's Social Security Number
3oq-6G -gSog
-7-9,1 Cash Tips Received from record above
KM
Employer's Name and Address Period for which tips were received
City of Carmel From (date)
One Civic Square /
Carmel, IN 46032 To date
Employ gna ur Date
/Saturday, April 27' 2013 5:17:17 PM
RE' ip,, REPRINT 491,
Broo hi Golf Club 0
119 C
RECEIPT #:202073 USor:8r0OkaU01O
------------------------------------------------- Invoice No. 04/37/2013
Item ¢
Bill To llmFletchaU
Description
Qty Price Total Address
________________________
1124
Banquet Payment
l $436.00 $436.00
------------------------------------------------- Phone
Grand Total: �436.0U
E-Mail
****V1S8: $436.00
Change: $0.00
|
|
Credit Card 0: l3
Tim L FletchmU
Approval COUo:005937 Exp:XX/XX
Reference #:2914
Thank you for playing 8rnOkShLr8 Golf Club!!
In C8s8 of s9Y8r8 H83tU8r Or lLAN1DK. play at
your own risk!
NOW BOOK ONLINE @ HNN.UrOOk8h1re0O\f.CON
14/27/2013 26 Bottle Sodas
Subtotal 1 358.50 i
Total
�
GRAND '—.��
Tax Exempt # |
�
� Thanks for us serve
Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/27/13 Tip Tip $45.23
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.
ALLOWED 20
Brad Gentry
IN SUM OF $
7811 Musket St. Apt. A
Indianapolis, IN 46256
$45.23
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I Tip I 42-390.40 I $45.23 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
Wednesday, May 01, 2013
Director, Brooks e Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by Slate Board of Accounts MILEAGE CLAIM General Form No.101 (1955)
TO��YLC 1 a✓ '� J4 - �Q/rY1,c ,� DR.
(Governmental nit)
nn On Account of Appropriation No. r �'lea c-
t Z-�� 6J<���.r-� C��� C��� y 3� D'-1 for �
Office,Board, Department or Institution)I
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE @ 156
2013 Point Point Start Finish TRAVELED PER MILE
- 14
�9 13 lt nJ —714 1
Auto License No. TOTALS 14TV
* SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legall after
allowing all just credits, and that no part of the same has been paid.
Date
Claim No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as requt
by law;
That it is based upon statutory author
That it is correct
3 (�� apparently L incorrect
On Account of Appropriation No: 30 for
Disbursing Officer
O
Allowed 20 n
in the sum of $ o �.
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