243199 3 /18/2015 CITY OF CARMEL, INDIANA VENDOR: 367453
® it ONE CIVIC SQUARE MARY EVANS CHECK AMOUNT: $*******225.71*
CARMEL, INDIANA 46032 14831 BIXBY DRIVE CHECK NUMBER: 243199
WESTFIELD IN 46074 CHECK DATE: 03/18/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4343000 REIMB 225.71 TRAVEL FEES & EXPENSE
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Carmel • Clay
Parks&Recreation
to ee Ex ense Reimbursement Re u ;i rtTr '��' 4� i-�Ce
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Date of Fund Account Account
Receipt Vendor listed on receipt I # Line# Budget Description Amount Purpose of Expense
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All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: ��fL
Employee Name(print) % 1
Address 1 l d>>
Check
payable to: City, St, Zip
Signature: Approved by:�.
Date: �j /� /D`lJ� Date: SMIZo S
Business Services Division,Revised 7-7-08
FILE: Shared\Forms\Business Services\Employee Exp Reimb Request
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Carmel • Clay
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
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IAll receipts should be attached in the same order as listed above.
lMo sales tax will be reimbursed. TOTAL:
Employee Name(print) I ��TAL -CCT -I
Address
Check
payable to: City, St,Zip 1@ 8
Signature: Approved by: )"`
Date: 7j Date: 3 I0 zc'
Business Services Division,Revised 7-7-08
MAR .o 281y
FILE: Shared\Forms\Business Services\Employee Exp Reimb Request BVI
LA
LoEWS
CHICAGO O'HARE
HOTEL
Mrs.Mary Evans Room Number: 0925
1411 E 116th St Arrival Date: 03-04-15
Carmel IN 46032 Departure Date: 03-08-15
United States Confirmation Number: 12323391
Merchant Ref#:
Page No: 1 of 1
Guest Name:
INFORMATION INVOICE
Folio No: 03-08-15
Date Description Charges Credits
WMI
03-07-15 Parking-Self 40.00
03-08-15 XXXXXXXXX' XX/XX 40.00
Total 70.00 70.00
Balance 0.00
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Continuing Education Credit Completion Form
EMPOWERI Fusion 2015 - Rosemont,IL - March 5-8,2015
Eair "'W.
8am-9:30am C to
Keynote with Peter Twist"Coaching Yourself to
9:45-11:15am Greatness: The Master Habits to 7 Forms of Wealth"
11:30am-fpm CQ I AR3
Friday
March 6 2pm-3:30pm pb u- 05
3:45pm-5:15pm t'
5:30pm-7pm
- -7am=8:30am- 1
8:45am-10:15am �j u `- o
Saturday 10:45am-12:15pm OkAy M 97:=Fca
Mara'71:15pm-2:45pm r— Rom(-BiL'p1�
3:45pm-5:15pm
5:30pm-7pm 210 Plovu eo-T ANAUNSLrls
8am-9:30am
Sunday 10am-11:30am Jje%A. 0V
March 8 12:15pm-1:45pm O:T , '�
2pm-3:30pm CFIFS to 5
TOTAL EARNED4
EMPOWER!does not determine the number of credits assigned per session. Please contact your certification agency with any
questions. Once this form is filled out,please submit to your education provider.
_;lwa.ary� r,
1.5 hour Lecture 0.15 1.5 1.5 0.1
1.5 hour__ Workshop 0.15 1.5 1.5 0.1
Max Credits Offered
Provider/Approval# Full Main Conference Friday Saturday Sunda
ACE CEP83122 2.2 0.8 0.8 0.6
AFAA 10845 24.0 9.0 9.0 6.0
NASM 528 1.6 0.6 0.6 0.4
Life Time EMPFSN2015 24.0 9.0 9.0 6.0
Full Main Conference(Friday-Sunday)
Your Name Your S gnat, re Date
v
Provider Signature
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.
367453 Evans, Mary Terms
14831 Bixby Drive
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
3/9/15 Reimb Travel expenses Fitness Conference $ 225.71
Total $ 225.71
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.
367453 Evans, Mary Allowed 20
14831 Bixby Drive
Westfield, IN 46074
In Sum of$
I
I
$ 225.71 i
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#or INVOICE NO. CCT#/TITL AMOUNT I Board Members
Dept#
1091 Reimb 4343000 $ 225.71 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 wore ordered and
received except
i.
March 12,2015
I' Signature
$ 225.71 h Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund