222837 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 365288 Page 1 of 1
ONE CIVIC SQUARE KURTIS BAUMGARTNER CHECK AMOUNT: $25.00
CARMEL, INDIANA 46032 16930 KINGSBRIDGE BLVD
WESTFIELD IN 46074 CHECK NUMBER: 222837
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4344100 REIMB 25 . 00 CELLULAR PHONE FEES
Carmel 0 Clay
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
7/19/2013 AT&T $ 25.0.0 Cell R imbursement
1All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $25.00
_
Employee Name(print) Kurtis Baumgartner
Check
Address 16930 Kingsbridge Blvd j JUL 18 2013
!
payable to: City, St, Zip Westfield, IN 46074
Signature Approved bycssz _.�__
Date: 7 I I Date. , 1�ILK
Business Services Division,Revised 7-7-08
FILE: Shared\Forms\Business Services\Employee Exp Reimb Request
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DUE BY: Jul 19,.2013, $180.14
KURTIS BAUMGARTNER
Account Number 243007377604 16930 KINGSBRIDGE BLVD
���} WESTFIELD,IN 46074-7800
` Please include account number on your check.
Make checks payable to:
❑ CHECK FOR AUTO PAY AT&T MOBILITY
(SEE REVERSE) PO BOX 6416
CAROL STREAM IL 60197-6416
9740D24300737760400DOD00001801400000018014009
3028.13.555.124692 1 AV 0.360 6n AutoPay Enrollment
If I enroll in AutoPay, I authorize AT&T to pay my bill
II"II�I11�"illl���ll'III'll��illlllllll���lllll'�I�III'I"'�"I monthly by electronically deducting money from my bank
account. I can cancel authorization by notifying AT&T at
KURTIS BAUMGARTNER www.att.com or by calling the customer care number
16930 KINGSBRIDGE BLVD listed on my bill.
WESTFIELD IN 46074-7800 Bank Account Holder Signature:
Date:
1
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.
365288 Baumgartner, Kurtis Terms
16930 Kingsbridge Blvd
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
7/19/13 Reimb Cell phone charges Jun'13 25.00
I i
Total $ 25.00
I hereby certify that the attached invoice(s), or bill(s)is(are)true and correct and 1 have audited same in accordance
with IC 5-11-10-1.6
20_
Clerk-Treasurer
Voucher No. Warrant No.
365288 Baumgartner, Kurtis Allowed 20
16930 Kingsbridge Blvd
Westfield, IN 46074
In Sum of$
$ 25.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or Board Members
INVOICE NO. ACCT#/TITL AMOUNT
Dept#
1091 Reimb 4344100 $ 25.00 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
8-Aug 2013
Signature
$ 25.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund