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Home My WebLink About257775 04/26/16 �o±.4�ay / CITY OF CARMEL, INDIANA VENDOR: 355319 t ONE CIVIC SQUARE MICHAEL KLITZING CHECK AMOUNT: $*******669.77* �. =a CARMEL, INDIANA 46032 1550 REDSUNSET DRIVE CHECK NUMBER: 257775 'M,��oN_�` BROWNSBURG IN 46112 CHECK DATE: 04/26/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4343000 042516 669.77 TRAVEL FEES & EXPENSE 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 SIU Allen Symposium;Banquet 3/31/2016 SIU Alumni Association 101 1125-1-00-4343000 Travel Fees $25.00 A Dinner on 4/14 Lunch while traveling for SIU Allen 4/13/2016 McDonalds 101. .1125-1-00-4343000 Travel Fees $4.32 Symposium Dinner while traveling for SIU 4/13/2016 Pagliai's Pizza 101 1125-1-00-4343000 Travel Fees $11.49 Allen Symposium SIU Allen Symposium;Lodging for 4/13/2016 Giant City Lodge 101 1125-1-00-4343000 Travel Fees $310.36 4/13&14(2 nights) All receipts should'be attached in the same.order as listed above. No sales tax will be reimbursed. TOTAL: $351.17 Employee Name(print) Michael Klitzing Address 1550 Redsunset Dr. Check payable t : City, St, Zip Brownsburg, IN 46112 Signature: Approved by: Date: 4/18/201.6 Date:. Business Services Division,Revised 7-7-08 FILE: Shared\Administrative\Forms\Staff Forms\Employee Exp Reimb Request 325 BUY ONE GET ONE FREE QUARTER POUNDER W/CHEESE OR EGG MCMUFFIN Go to www.mcdvoice.com within 7 days and tell us about your visit. Validation Code: Expires 30 days after receipt date. 1+ Valid at participating US McDonald's.__ 1033 N MAIN CLOVERDALE IN 46120-9706 ! ! ! THANK YOU 1 1 1 TEL# 765 795 3332 Store# 5216 KS# 3 - Apr.13'16 (Wed) 14:43 MFY SIDE 1 KVS Order 25 QTY ITEM TOTAL_ 1 Bag 0.00 2 Cheeseburger 2.00 NO Onions TA @m 18-9mbur29e d mm Plain 2 Cranbery Orng Muffin 14- 2.00 2 L Coke - 6 -2- 2.00 t,00 Subtotal 8.00 Tax 0.64 o,32 Take-Out Total 8.64 Cashless 8.64 tt 3Z, Change 0.00 MER# 19844402 CARD ISSUER ACCOUNT# Amex SALE ***********2005 AUTHORIZATION CODE - 580699 SEQ# 744353 We want you to be HIGHLY SATISFIED with your overall experience at our McDonald's. If you have any concerns please feel free to contact us at: Cloverdale McDonald's - (765) 795-3332 OR Main Office - (765)653-0371 Thank You l �I,Zz Ou rPags . corn DATE 04/13/2016 WED TIME 18:44 Pizza T1 $11.05 Pizza T1 $1.25 Pizza T1 $1.25 Beer $3.95 Beer $3.95 Tip Amt $4.60 SUBTOTAL $26.05 TAXI s- $1.19 TOTAL $27.24 Credit $27.24 --------------------------------- SALE C� 27.24 ***********2005 APP : 546479 REF : 00000041 REC NO : 41 ---------------------------------- 000044 2a ' x7 ' 49 Giant City Lodge 460 Giant City Lodge Road Makanda Illinois, 62958 618-457-4921 'er: A.M. 04/13/2016 5:20 PM ;ts: 1 10023 f 1-2 (2 @139.00) 278.00 'f 1-2 (2 @159.00):] 318.00 -iday-Saturday total 596.00 l 1.c9`1`jo 69.37 �1 665.37 Earned 159.00 #XXXXXXXXXXX2005 506.37 ith:569851 Exp 0619 lance Due 0 . 00 Thank You Please Join Us Again 3/31/2016 SIU Alumni Association-SIUF John Allen Student Syposium GIVE NOW Home About Us Priorities Making a Gift Financials News&Events Contact Us Dinner$25 Registrant-:�Guests a Organization Informaton->Billing a Review a Finish FairMarlretValue$19 Congratulations,Michael,your transaction has been processed successfully.Please print the below information for your records. pq SIU Carbondale and the SIU Foundation retain a small L•J Add to my calendar percent of all gats to enhance philanthropic-related Transaction Summary !Me lives. For our charitable.disclosure information, please visit www.siuf.om Description Amount . Confirmation Number.285493 Selection $50.00 Quantity 2- r Inn` 25.0 Additional Donation , $200.00 Total:$250.00 Billing Information Full Name: Michael IN Klitzing Billing Email: mklitzing@carmelclayparks.com Billing Phone: 317-450-1250 Billing Address: 1550 Redsunset Dr Address 2: City: Brownsburg State: IN Zip/Postal Code: 46112 Country: US Credit Card Information Type of card: AMEX Credit Card Number: -*2005 REGISTRANT Michael Klitzing Registrant First Name: Michael Last Name: Klitzing Primary E-mail Address: mklitzing@carmelclayparks.com hftps://secdrelb.imodules.com/s/664/foundation/index.aspx?sid=664&gid=1&pgid=2960&cid=6382&fid=6382&fb_ciuid=919581 ca-b87c-40c6-9e0a-f83a... 1/3 3/31/2016 SIU Alumni Association-SIUF John Allen Student Syposium Address 1: 1550 Redsunset Dr City: Brownsburg State: Indiana Zip: 46112 Phone Number: 317-450-1250 Selection Selection Dinner-$25.00 Meal Event Dinner Additional Donation $200.00 GUESTS David Goris First Name: David Last Name: Goris Primary E-mail Address: mklitzing@carmelclayparks.com Address 1: 1550 Redsunset Dr City: Brownsburg State: Indiana Zip: . 46112 Phone Number: 3174501250 Selection Dinner-$25.00 Meal Event Dinner ORGANIZATION INFORMATON Organization Information Is this a gift from your Organization/Company? NO https://securelb.imodules.com/s/664/foundation/index.aspx?sid=664&gid=1&pgid=2960&cid=6382&fid=6382&fb_ciuid=919581 ca-b87c-4Oc6-9eOa-f83a... 2/3 � f4 GIMIERAL FORK NO.101(ices) PRESCRIBED BY STATE BOARD OF ACCOUNTS p MILEAGE CLAIM tj_ rTo 'iGovEANMENTAL UMTI ✓n ON ACCOUNT OF APPROPRIATION NO. FOR tong CE.ROAM DEPARTMENT OR 1NSnTUT1ON( SPEEDOMETER AUTO MILEAGE DATE FROM TO READING + NATURE OF BUSINESS MILES Yfi I�' POINT POINT START FINISH TRAVELED PER% ` J 1 • 4, a z, Apr. I TOTALS AUTO LICENSE NO. l �� + SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. Pursuant to the provisions and penalties of Chapter 155,Acts 1953,1 hereby certify that the foregoing account is just and correct,that the amount claimed is legs ly due,after allowing all just credits end that no part of the same has been paid. Date _ 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. 355319 Klitzing, Michael Terms 1550 Redsunset Dr Date Due Brownsburg, IN 46112 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 4/18/16 Reimb Travel Expenses for SIU Allen Symposium $ 351.17 4/18/16 Reimb Mileage for SIU Allen Symposium $ 318.60 Total $ 669.77 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 i Voucher No. Warrant No. 355319 Klitzing, Michael Allowed 20 1550 Redsunset Dr Brownsburg, IN 46112 ,InSum of$ :L $ 669.77 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1125 Reimb 4343000 $ 351.17 1 hereby certify that the attached invoice(s), or 1125 Reimb 4343000 $ 318.60 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 April 20, 2016 Signature $ 669.77 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund