242437 02/17/15 CITY OF CARMEL, INDIANA VENDOR: 354379
® 'I ONE CIVIC SQUARE JEFFREY WORRELL CHECK AMOUNT: $**.....225.00*
a° CARMEL, INDIANA 46032 12550 SCOTTISH BEND CHECK NUMBER: 242437
CARMEL IN 46033 CHECK DATE: 02/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1203 4343004 CABLE TV 225.00 TRAVEL PER DIEMS
nr
Earmet Cabte aub Eeterommuuiratio no Commig5iou
One Cibir.6quare - Carmel, 31.E 46032
February 10, 2015
Ms.Nancy Heck, Director
Dept. of Community Relations &Economic Development
City of Carmel
One Civic Square
Carmel, IN 46032
Dear Nancy:
The following Commission members attended the Carmel Cable & Telecommunications
Commission regularly scheduled meeting on Tuesday, February 10, 2015, and are entitled to a
payment of stipends in the amount of$75.00 each in accordance with Ordinance D-2185-14, as
Amended:
Commission Member Stipends
Christi Cloud $75.00
James D. Garretson $75.00
Joseph C. Griffiths $75.00
Winston Long $75.00
Jeff Worrell $75.00
Very truly yours,
Sharon M. Kibbe
Recording Secretary
Copy: Winston Long, President
STATE OF INDIANA )
) SS:
COUNTY OF HAMILTON )
Affidavit for Payment of Stipends
The undersigned, being duly sworn upon his/her oath, depose and says that he/she
is a duly appointed and acting member of the Cable and Telecommunications
Commission for the City of Carmel, Indiana, and that this Affidavit is submitted for the
purpose of identifying those Commission meetings that the undersigned personally
attended between November 13, 2012 and November 13, 2014, and to request the
payment of stipends from the City of Carmel to the undersigned in accordance with
Ordinances D-2046-11, D-2104-12, D-2150-13, as Amended.
Commission Meetings Attended Stipends
February 13, 2014 $75.00
August 12, 2014 $75.00
Total $150.00
(14�ta
Jef W ell
Subscribe and sworn to before me, a Notary Public, in and for said County, this
day of ruar , 20J5.
—D.Ly commission ex ires:
LAIIgh
a . Printed: hn ,Notary Public
Residing in County, Indiana
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))
02/10/15 Letter $75.00
02/10/15 Affidavit $150.00
1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Jeff Worrell
IN SUM OF$
12550 Scottish Bend
Carmel, IN 46033
$225.00
ON ACCOUNT OF APPROPRIATION FOR
Community Relations
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1203 Letter 43-430.04 $75.00_ I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1203 Affidavit 43-430.04 $150.00
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, February 16,2015
Director, Comm ity Relations/Economic Development
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund