246226 06/17/15 ♦�a-cggMF
CITY OF CARMEL, INDIANA VENDOR: 367943
J/ �, ONE CIVIC SQUARE TRACI BROMAN CHECK AMOUNT: $********77.92*
-•i?. % CARMEL, INDIANA 46032 C/O PARKS CHECK NUMBER: 246226
'�,;�oN�o` CHECK DATE: 06/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 REIMB 27.92 GENERAL PROGRAM SUPPL
1096 4239039 REIMB 50.00 IND BEER WINE PERMIT
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
rM
elitrMarsh e. o. 4Q0101 Sup, 4- Icy
r CAMPM4
All receipts should be attached in the same order as listed above. ^ n
No sales tax will be reimbursed. TOTAL• d'�-t`•`'�
Employee Name(print) Tra U Bwlm an �
Check
Address
��Eu 32 oranaI MOSSdm -M JUN - 9 2015
payable to: City, St,Zip �S►1 � �IV �'�p(�?�V __.__,___--��
Signature: Approved by:
Date: �f i5 Date:
Business Services Division,Revised 7-7-08
FILE: Shared\Administrative\Forms\Staff Forms\Employee Exp Reimb Request
- � Carmel e Clay
JUN 10 2015 Parks&Recreation
BY: Employee Expense Reimbursement Request
Date of_ Fund Account Account -
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
�1 �5 PMo a� C,InaS� O.W ,4�39o3q Cn Prom.Su i $(5o.o0 1To �CCCo c mo Ai m
Loq 1iSSi
for\cy, ttm i
All receipts should be attached in the same order as listed above. I�-�
No sales tax will be reimbursed. TOTAL: 4�•W
Employee Name(print)—Tro'u Mman
Address ()YQI((l a.e, &I)SSOrn Tiz�i l
Check
payable to: City, St, Zip TjSV\Cn jt �
Signature: Approved by:
01
Date: f 5 Date:
Business Services Division,Revised 7-7-08
FILE: Shared\Administrative\Forms\Staff Forms\Employee Exp Reimb Request
iELI
CHASE
Terms and Conditions (Remitter and !Payee): JUN 10 2015
,,/ _
J Please keep this copy for your record of the transaction —
* The laws of a specific state will consider these funds to be "abandoned"
if the Cashier's Check is not cashed-by a certain time
- Please cash/deposit,/this Cashier's Check as soon as possible to-
prevent this from occurring
- In most cases, the funds will be considered "abandoned"
before the "Void After" Date
* Placing a Stop Payment on a,Cashier's Check
i - Stop Payment can only be placed if�the Cashier's Check, -
J -is lost, stolen, or destroyed
-We may_not re-issue or refund the funds after the stop payment has 1
- - - _ pp Y ;
been placed until 90 days after the original check was issued
* Please visit a Chase branch to report a lost, stolen, or destroyed Cashier's Check
or for.;any,other information about this item
FOR YOUR PROTECTION SAVE THIS COPY Customer Copy
} CASHIER'S CHECK 1 19045717690
/ 06/08/2015
r Void after 7 years
l
Remitter:,, TRACI ANN BROMAN
J 1`,-50.00 *,
Pay To The INDIANA ALCOHOL & TOBACCO COMMISSION
Order Of:
----------------- Drawer: JPMORGAN CHASE BANK, N.A. /
Memo:--------------------------------------------------- N NEGOTIABLE
Note:For information only.Comment has no effect on bank's payment. NON I
S7Ar
BEER&WINE AUTHORITY/TYPE 118 Send,deliver,or mail to:
State;Form 35494 District#1 52422 County Rd 17 District 04 651:S.Frontage Rd
z
'd,•• - '
(R6110-06 Approved by Bristol,IN 46507 Seymour,mour,IN 47274
812-523-8314
State Board of Accounts Phone::574 264-9480 Phone.
2014
INSTRUCTIONS: 1.Applicant must complete all requested information. District#2 1353.S.Governors Drive Distrix#5 .3650 S.US Hwy 41
2.Please type or print clearly. Columbia:City.IN 46783 1Uncennes,•IN 47591
3..Submit applicatlon.and payment to the local excise Phone:260-2444285 Phone:812-882-1292
district office.
District) 279 W.County Rd 300 N District#6 6400 E.30th St
Crawfordsville,IN 47933 Indianapolis,IN 46219
Phone:765-362-8816 Phone:317-5414100
�rl:I�i` Gf= IERAI± FORMA'tIOI x. ., _
Name of applicant applying for permit.(organization,club,;corporation,.Iridividual) TM TM Permit#(Issued by ATC)
ca ';0 tbn nari�car KS 1 c onn
Address:(number'and strei&,'city,state,ZIP code)
1235 ATO t ark . IF- Car+m t, t tou32
Name of person:making application. Fax Number Emergency contact telephone number
Tt'ad gMM� ( fin 5 3.52- (30 ) '15-13:52 3
Printed name of contact person of:event ddress Emergency contact telephone number
Tvad Bywan Sarni as above- 3n �73.� to52
572EE1dT„MFORAIIATION
y
Beginning� ��� {�, - Ending
Day1rnUISS- bated ,���/ Day Date d 1`6
Times of function: AM 1 2 AM
Start-1130 End
Type or description of event
mein . WX>er Na over -k event at -the. Wad ate:)
Exact addtess,of.:event(number end sireet.clfy state,ZIP code)
�1°r5 c�W Pc k r. W carmet, 11Q AW32
STEP 3 "For P,
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1 ' ° tits,ball Tables v It 1113 �—
�a-~^�u ���i 'rs'�-'• mfg++' �•/1 iJ- ur-.f.' Af,K tq.r� .r1 � `.` a ��yf ° i7 :s:..
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� `� .�'�'� wr. .._,'� "�� R,:✓ �� k r r�aR r � � ae e 3 egg.`..:,"".�!{.� �� l,r'°'�^� � ':" "3m,��""
In order to qualify for this authority to serve;beer&wine, the following guidelines_must be met:
1. There must be,a well defined premise, i.e. building, tent, enclosure, or fenced-in or designated
area.
2: You must have a defined floor.plan or diagram,. This is to be drawn on Page 1, Step 3 of this
application..If minor are to be present you must have a defined separation between the bar area
and family area.(Must be on floor plan).
3. There shall be NO carry-out privileges, NO carry-in privileges and NO spirituous beverages
allowed
4. Eadi applicant must:'designate an:individual to be responsible foe the event and such,person shall
sign the':authority.
5.. ANY and ALL persons.:dispensing or accepting payment for alcoholic beverages MUST POSSESS
- a valid ATC employee permit.
6. The event must meet,applicable Boardof Health requirements, particularly with.regard to restroom
facilities.
7. .If the:event isheld in a town park,you must have approval from the town board.
8. Legal hours.of-dispensing alcoholic beverages(Prevailing Time); Monday through'Saturday lam to
3am the following:day:Sunday-lam to 3am the.following day.
9. Applicant mustfile with the.district office at which the event will be held:at least-16 days prior to the
event. Failure to.comply will be grounds for denial.
10. This authority must be posted in the most conspicuous place at the location of the event. An
Excise Officer or Commissioner,.for good cause, has the authority to.revoke.the authority during
-the.event.
w�wws,«wl�.tn:«`;." L. �• 'b. .,.., ,di«s}au...e: ,�"`� '''"eau,»:... `
1. Signature chief of Police,or Town Marshal w e the'vent's td be located. Z Signature of Mayor(lf'event is held InTort Wayne
Note:
Plea poSt.your-approved request In a conspicuous place where the alcoholic-beverages are being dispensed at the location.
If for any reason this request is denied,you maybe notified.either In person or by phone.
1 swear or affirm undeupenalties of perjurythat the.informatlon istrue and accurate. _
Signature of permittee/agent: Date(month,day,year.):
(Your signature acknowledges that you have read:and wall abide by.the rules andguldeltnes,)
District number Date issued(month,day,year)
RevlewedbyEc!se D&dRW-wtah:
Approved Denied
1. ALL EVENTSARE:$50 00.PER DAY. BUS(NESS,CHECKS OR MONEY ORDERS ARE ACCEPTED MADE OUT TO THE INDIANA ALCOHOL&
TOBACCO COMMISSION: .
2. SERVING'PAST MIDNIGHT,NO LATER THAN3. A.M.,IS ONE DAY.,
3. NO RAIN CHECKS ON ANY OF"THE ABOVE EVENTS.
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.
367943 Broman, Traci Terms
14432 Orange Blossom Trl
Fishers, IN 46038
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
6/5/15 Reimb Marsh- Extra water& ice for campout $ 27.92
6/8/15 Reimb IN Alcohol Commission beer/wine permit $ 50.00
Total $ 77.92
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.
I
367943 Broman,Traci Allowed 20
14432 Orange Blossom Trl
Fishers, IN 46038
In Sum of$ ,
$ 77.92
ON ACCOUNT OF APPROPRIATION FOR'
109 -Monon Center
I,
PO#or1 Board Members
Dept# INVOICE N0. CCT#ITITL AMOUNT:
11 .
1096-60- Reimb 4239039 $ 27.92. 1 hereby certify that the attached invoice(s), or
1096-60 Reimb_- 4239039_ $ 50.00 bill(s)is(are)true and correct and that the
materials or services itemized thereon for
Which charge is made were ordered and
r received except
June 11,2015 ,
'P
I&hWWYUAJ
Signature
$ 77.921, Accounts Payable Coordinator .
Cost distribution ledger classification if ` I Title
d,1 ,
claim paid motor vehicle highway fund