HomeMy WebLinkAbout233068 05/28/14 `'�.�,qMF CITY OF CARMEL, INDIANA VENDOR: 35.5078
i'. ONE CIVIC SQUARE RYAN JELLISON CHECK AMOUNT: $""'""`"189.00'
_� CARMEL, INDIANA 46032
CHECK DATE: 05/28/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 189.00 TRAINING SEMINARS
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CITY OF CARMEL Expense Report (required for all travel expenses)
EMPLOYEE NAME: Ryan Jellison DEPARTURE DATE: 5/3/2014 TIME: 3:00 AM/10
DEPARTMENT: Police RETURN DATE: 5/6/2014 TIME: 7:00 AM/
REASON FOR TRAVEL: ISOA Conference DESTINATION CITY: Ft. Wayne, In
EXPENSES ARE FOR (check all that apply) TRAVEL ADVANCE TRAVEL REIMBURSEMEN' TRAVEL PER DIEM X
Transportation Gas/Tolls/ Meals
Date Lodging Misc. Total
Air-fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
5/3/14 $'1 $25.00 °
5/4/14 $50.00 $50.00
5/5/14 $50.00 -$50.00
5/6/14 $50.00 $50.00
$0.00
-.-'$0.00
$0.00
$0.00
'$0.00
'$0.00
$0.00
°$0.00
$0.00
$0.00
-$0.00
$0.00
$0.00
$0.00
$0.00
0.00
Total $0.00 $0.00 ' $0.00 ��, I $0.00 $0.00 $0.00 .$0.00 $0.00 $175.00 $0.00 kg , 00
DIRECTOR'S STATEMENT: I hereby affirm that all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date:
City of Carmel Form#ER06 Revision Date 5/7/2014 Page 1
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CAIN $ 14°00
Total Fee $ 14.00
CASH PAID $ 14e00-
Cash Tender s 14000
Change Dile $ 0.00
FOR OFFICIAL USE ONLY ATTENDEE
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11 th Annual Conference May 4th-6th
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❑$175 Conference Fee ❑$20"Junkyard Shootout"Match
CJ$25 Late Fee(Aver April 18,2014)
Total:$ .00 ❑Additional Banquet Tickets @$50 each
An application form must be submitted for each and every attendee
FlRST NAME M.I. LAST NAME
P1 l 5 orgy
AGENCY I ASSIGNMENT/RANX/TITLE
AGENCY ADDRESS CITY i STATE ZIP CODE
3 v� S c, Z_
MAILING ADDRESS(OTHER THAN AGENCY) CITY STATE ZIP CODE
E-MAIL ADDRESS PHONE
-72
I affirm that the above information is true and accurate. Further, I authorize the Indiana SWAT Officers Association
to contact my employer and verify my employment and assignment, if necessary.
SIGNATURE DATE
IMPORTANT: Will you be attending the banquet? "S ❑No Number of additional tickets requested: e�
Federal Tax ID Number. 57-1177923
You are considered pre-registered if your registration form* and payment (agency purchase order, check, credit card*, DOJ
voucher, or money order) are received prior to April 18,2014. Any registration form received after April 18, 2014,will result in a
$25.00 late fee. NOTE: We WILL NOT accept registrations on the day of the Conference. Additional banquet tickets can be
purchased for$50.00 per ticket(limited quantity available).
*Registration fee includes: Attendance at Conference, Vendor Appreciation Day,lunch and
banquet dinner on Monday,May 5th,and lunch on Tuesday,May 6th
*There will be a$3.00 additional processing fee for credit card payments
If you are pre-registered and cancel prior to April 18, 2014, your registration fee will be refunded less a
$50.00 administrative charge. No refunds will be issued after April 18, 2014. However, suitable
substitutions will be allowed.
If paying by credit card, please complete the following: �`v'SQ 0 D1WVE9
CREDIT CARD NUMBER EXPIRATION DATE 3 DIGIT AUTHORIZATION CODE
NAME ON CREDIT CARD !AUTHORIZATION SIGNATURE
{
ADDRESS I CITY STATE ZIP CODE
IMPORTANT: Your credit card will be charged the day your registration form and payment are received by the ISOA.
Please include the billing address where the monthly statement is sent.
PLEASE CHECK.' ❑FULL-TIME ❑ PART-TIME ❑ RETIRED ❑AUXILIARY/RESERVE ❑ACTIVE MILITARY ❑RESERVE MILITARY
• o- • TO
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Ryan D. Jellison
IN SUM OF$
$189.00
ON ACCOUNT OF APPROPRIATION FOR
CPD Continuing Ed Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
210 -570.00 $189.00
I hereby certify that the attached invoice(s), or
I I I
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
Friday, May 23, 2014
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
05/23/14 ISOA Conference, Ft Wayne, IN $189.00
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