HomeMy WebLinkAbout239/61 12/03/2014 w t�qy
>`' CITY OF CARMEL, INDIANA VENDOR: 362732
;; ® ONE CIVIC SQUARE PAMELA LISTER CHECK AMOUNT: S""""196.56'
CARMEL, INDIANA 46032 11598 MANSFIELD PLACE CHECK NUMBER: 239761
'd;,�uH Lo r, CARMEL IN 46032 CHECK DATE: 12/03/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4343004 35.28 TRAVEL PER DIEMS
1207 4239040 BANQUET TIP 161.28 FOOD & BEVERAGES
p� CLAIM General Form No, 101 (1955)
scrlberi by Stale Board of Accounts 99 ILEAGE C�./� IM
ro TOP-iE'- DR.
'Yl overnmantanit) f
' On Account of Appropriation No. for +� C9Lr
i
Off ce,Boar , epartment or ns to on
TO ODOMETER READING* NATURE OF BUSINESS AUTO MILES MILEAGE
FROM giadFinish TRAVELED PER MILE
DATE ` ' Point
` Point
20 ,� sa G 7
� , �� 319.2
It t 7
VA' 17 1712
TOTALS
Auto License No.
e to be used only when distance between points cannot be determined by fixed mileage or official highway map.
* SPEEDOMETER READING colt lrnns are account is just and correct,that the amount claimed ' egali due,after
ns and penalties of Chapter 155;Acts 1953,,I hereby certify that the foregoing
Pursuant to the pro
visio P
allowing all
'Just credits, and that no part of the same has been paid.
Claim No. Warrant No•________ I have examined the within-claim and
hereby certify as follows;
IN FAVOR OF
That ft is in proper form;
�� --- Thdt it is duly authenticated as requi
by law;
- _ That it is based upon stck tory author
f correct
f$ '
That it is apparently incorrect
U _
for f Appropriation No. -
Disbursing officer.
Allowed _ • - _`_ -- _ (OD n
in.the.surn Of 0
gS=� _ o �.
(OD
o _ F
_ -
_ (Bocact or Commission) .
_. FILED �.
. R
(an
(officlal Title)
/ �tl•Y•T�a21H�N
- CITY OF CARMEL Expense Report (required for all travel expenses)
���NDIpNP�� EXHIBIT A
EMPLOYEE NAME: S DEPARTURE DATE: TIME: AM/PM
DEPARTMENT: RETURN DATE: TIME: AM / PM
REASON FOR TRAVEL: DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
in
Transportation Gas/Tolls/ Lod Misc. Total
Date Air-fare Car Rental Other Parking Lodging Meals Breakfast Lunch Dinner Snacks Per Diem
7,
4.I.
r.'
Total
DIRECTOR'S STATEM ereby affirm th all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: r Date: �/� ' l"lq
City of Carmel Form#ER06 Revision Date'10/17/2006 Page 1
Invoice
Date: 11/1/2014
Bill To: Nicole Brink
Address:
Brookshire Golf Course Phone: 317-379-2269
. 12120 Brookshire Parkway Email: nbrinkPmexom
Carmel, Indiana 46033 :
brookshiregolf.com
Deposit Received
Amoun ` .
Room Rental 4 hrs @ $100.00 per hr. $400.00
Food An Pasto $130.00
Chicken/Bacon Ja [ Skewers $130.00
Shrimp Cocktail $150.00
Chicken Cornucopia $120.00
!. Veggie Tray $100.00
Snack Mix $60.00
Beef Wellington $160.00
Brie W/ Raspberry Sauce $160.00
300 Drink Pkg $1 ,200.00
12 Drinks @6.50 $78.00
Subtotal $ 21688.00
Tax Banquet @9% $ -
�A"� Gratuity 18% $ 483.84
Amount Due $ ,
Subtract Deposit $0.00
Grand Total $ 3,171.84
Thank you for letting us serve you !
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))
11/01/14 Banquet Tip Banquet Tip $161.28
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
Pam Lister
IN SUM OF $
11598 Mansfield Place
Carmel, IN 46032
$161.28
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I Banquet Tip I 42-390.40 I $161.28 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
Monday, December 01, 2014
J:
Director, Brooksh��olf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund