303827 10/06/16 %'4�p'' CITY OF CARMEL, INDIANA VENDOR: 00350224
`T` i. CHECK AMOUNT: $*****2,304.74*
.�; ® ,� ONE CIVIC SQUARE NANCY HECK
s• _,; CARMEL, INDIANA 46032 CHECK NUMBER: 303827
�M�I TON ca` CHECK DATE: 10/06/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1203 4359000 092616 41.17 SPECIAL PROJECTS
1203 4343004 100316 390.00 TRAVEL PER DIEMS
1203 4343001 100416 1,873.57 TRAVEL FEES & EXPENSE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
NANCY HECK ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IN SUM OF$ 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.
$1,873.57 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Community Relations Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
EXPENSE 43-430.01 $76.17 1 hereby certify that the attached invoice(s),or 10/3/16 EXPENSE $76.17
REPORT REPORT
1203 101 bill(s)is(are)true and correct and that the 1203 101
EXPENSE 43-430.01 $1,797.40 10/3/16 EXPENSE $1,797.40
REPORT materials or services itemized thereon for REPORT
1203 101 which charge is made were ordered and 1203 101
received except
Wednesday,October 05,2016
ti
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—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
CITY.OF.CARMEL Expense.Report (r 'qu.ired;for all travel 'expenses)
.. h H .. . . .. .. .. .. .. .. .. ..
E .
. XHIBIT.A . , :•: .
'EMPLOYEE NAME: . :_Nanny Heck_ DEPARTURE:DATE' .:Cj�. .. �.' .. ' TIME: ./ ::'. S. . AM. .PM
DEPARTMENT: Community Relations.&Economic Development .RETURN DATE: 6 2 '. /' TIME: /o :AM. PM."
REASON.'FORTRAVEL.:.' ' IM..LA.Conf&i9nce DESTINATION CITY: ". ;' Saa DiegO,,CA.
EXPENSES ARE FOR(check all that apply):TRAVEL ADVANCE : TRAVEL REIMBURSEMENT ' TRAVEL.PER DIEM X
ransportation aslTol
T G Is/ Meals
Date ,' Lodging Mise. ' Total
Air-fare.. .Car Rental ;. Other Parking Breakfast Lunch: Dinner Snacks, ; Per Diem
9/27/,16', • . ' ; :. . $27:63 . . '$404
'48 $65.00 $49711
:9/28/16 :
$1.0.35 : $348.23 :. : . ' .' " $65:00. :. . . . ;$=42358
9/29/16' $348:23 $65.00. : :. . $T41r3 23
9/3.0/16.'• : .. . : .. . $16.68 " $348'.23 . : .. . ' . $6500 $42991,
:10/1/1.6 ' : .$21.51 " $3.48.23 : .. . _ $65:00. . '. ::$434 74
:10/2/16 $65.0.0 ` $65:00
_t$Of00
• , � $000 .
$9 000
„ .
$OE00
$0 00 ,
000
;$0;00
.. . . �•• ., $000 .
00
Total;; : $0:00 .: : $0:00: $76.17: $0.00 $111 ,97.40,, .. . $0.00 . . -•,$0.00 '. . '$0:00: . •. '$0,00 • . •$390,001 '$0.00
' I'h'ereby:affirm that all-.expenses listed conform to the City's travel and are within my depaitment's appropriated budget.',',
DIRECTOR'S,
a
Direcfor;Signature: . • .: •. : Date:,. .
City of.Carmel Form.#ER06 Revision Date 10/3/2016 Page 1,
For advance:payments,'claim form must be:submitted ten:(10) business days inadvance:of travel:
Claim'will not be 6rocessed without the following documentation:
1) Conference or. course registration form;.if applicable
2) Travel,itinerary,or.car,rental agreement' if applicable•,.
3) Original.itemized:receipts for all.expenses(or affidavits.if appropriate), except for.meal.per diems(which require.hotel.receipt).: .
Prorated meal allowance: .
For travel.that coiimmences•before.1;00 m.:(flight de arture time,.if traveling b air , $50.for in-state travel and$65 for out=of=state travel:
P .: (. 9 P 9:. Y ) .
For fravel.'that,commences after 1:00 p.m:(flight.departure'time, if traveling by air),.$25 for in=state.travel and,$32:50 for,out-of-state travel . .
For:travel,that ends before 1:00.p.m: (flight arrival time, if,traveling by.air.), $25 for in-state travel and $32.50 for out=of-state travel.•
For.travel that:ends after 1.:Wp.m..(flight arrival time; if traveling by air);$50 for,in=state travefand:$65.f6r mit=of-state travel:.
EMPLOYEE ACKNOWLEDGEMENT OF MEAL ADVANCE AND OBLIGATION.TO DOCUMENT EXPENDITURES:
, :I-hereby acknowledge receipt.of$ ;such funds being advanced,to•'me bythe.City of Carmel solely'for the purpose'of purchasing:meals,
while traveling to participate in official,business for the.City. -I accept responsibility•for.these;fnnds and agree to repay:them:if lost.or_stolen..
I:understand that within.ten (10)business days of my return (as stated on opposite side),1 am,responsible to:
1) Submit original itemized receipts to•the office•ofthe he dobumentingall meal expenditures;'and
2). Return all unused funds to,'the'office of the Clerk-Treasurer
„further understand-that failure to:provide the required documentation shall result in the total amount of the•advance.being deducted.from.the fist
paycheck issued;more,than 30 days after:thedate of my return.* Failure to.return:unused,fuhds'will result in the amount of the unused funds (total
advance niirius.documented expenditures)'tieing.deducted;from the first paycheck issued more than.30 days after the date of.my return.
Employee.Signature:.. . . . :. Date: . • :.
City of Carmel Form.#ER06 Revision Date 10/3/2016 Page 2.
10/3/2016 Uber Riders-My Trips
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HILTON SAN DIEGO BAYFRONT
[� One Park Boulevard I San Diego,CA 92101
Hilton T: 619 564 3333 1 F: 619 3214316
SAN DIEGO BAYFRONT W:hilton.com
NAME AND ADDRESS:
Room: 2359/Q2V
-iECK, NANCY Arrival Date: 9/27/2016 4:33:00 PM
Departure Date: 10/2/2016 11:35:00 AM
Adult/Child: 2/0
JNITED STATES OF AMERICA Room Rate: 359.00
Rate Plan: 2G
HH#
AL:
Car:
Confirmation Number:3275200619
10/2/2016
DATE DESCRIPTION ID REF.NO CHARGES CREDITS BALANCE
HILTON
9/27/2016 GUEST ROOM ACOHENI 8483534 $359.00 HHONORS
9/27/2016 TRANSIENT ACOHEN1 8483534 $37.70
OCCUPANCY TAX
9/27/2016 SD TMD ASSESSMENT ACOHENI 8483534 $7.18
9/27/2016 CA TOURISM FEE ACOHENI 8483534 $0.60 :.}K
9/28/2016 GUEST ROOM ACOHEN1 8486305 $309.00
9/28/2016 TRANSIENT ACOHENI 8486305 $32.45
OCCUPANCY TAX
1':ONRi1U
9/28/2016 SD TMD ASSESSMENT ACOHENI 8486305 $6.18
9/28/2016 CA TOURISM FEE ACOHENI 8486305 $0.60
9/2912016 GUEST ROOM ABELL 8488716 $309.00
9/29/2016 TRANSIENT ABELL 8488716 $32.45
OCCUPANCY TAX ifiitc�La
9/2912016 SD TMD ASSESSMENT ABELL 8488716 $6.18
9/29/2016 CA TOURISM FEE ABELL 8488716 $0.60
9/30/2016 GUEST ROOM ABELL 8491307 $309.00
9/30/2016 TRANSIENT ABELL 8491307 $32.45
D;:Du:crrur.
OCCUPANCY TAX
9/30/2016 SD TMD ASSESSMENT ABELL 8491307 $6.18
9/30/2016 CA TOURISM FEE ABELL 8491307 $0.60
10/1/2016 GUEST ROOM ABELL 8493943 $309.00
10/1/2016 TRANSIENT ABELL 8493943 $32.45
OCCUPANCY TAX
10/1/2016 SD TMD ASSESSMENT ABELL 8493943 $6.18
10/1/2016 CA TOURISM FEE ABELL 8493943 $0.60 pp
.l.
ACCOUNT NO. DATE OF CHARGE FOLIO NO./CHECK NO.
VS 10/2/2016 1361256 A
CARD MEMBER NAME AUTHORIZATION INITIALa ""'''`
HECK, NANCY 027017
ESTABLISHMENTNO.a LOCATIONESTABIISIIMENTA,REUT.TMNS-ITTOCM.110EDERTORPAYMENT PURCHASES&SERVICES
TAXES
TIPS&MISC.
CARD MEMBER'S SIGNATURE TOTAL AMOUNT lir+.nrl Joc�t{uxs
-1,797.40
ME RCHANDISF.AND/OR SERVICES PURCHASED ON THIS CARD SHALL NOT BE RESOLD OR RETURNED FOR A CASH REFUND. PAYMENT DUE UPON RECEIPT
HILTON SAN DIEGO BAYFRONT
One Park Boulevard I San Diego,CA 92101
Iton T: 619 564 3333 1 F: 619 3214316
SAN DIEGO BAYFRONT W:hilt:On.COPn
NAME AND ADDRESS:
HECK, NANCY Room: 2359/Q2V
Arrival Date: 9/27/2016 4:33:00 PM
Departure Date: 10/2/2016 11:35:00 AM
Adult/Child: 2/0
ONITED STATES OF AMERICA Room Rate: 359.00
Rate Plan: 2G
HH#
AL:
Car:
Confirmation Number: 3275200619
10/2/2016
DATE DESCRIPTION ID REF.NO CHARGES CREDITS BALANCE U
HILTON
10/2/2016 VS*5916 RVERDUZCO 8495521 ($1,797.40) HHONORS
**BALANCE** $0.00
EXPENSE REPORT SUMMARY �yL
9/27/2016 9/28/2016 9/29/2016 9/30/2016 ".
ROOM AND TAX $404.48 $348.23 $348.23 $348.23
DAILY TOTAL $404.48 $348.23 $348.23 $348.23
EXPENSE REPORT SUMMARY
rctvtLn:a
10/1/2016 STAY TOTAL
ROOM AND TAX $348.23 $1,797.40
DAILY TOTAL $348.23 $1,797.40
has)
�IiitOAl
rte..
DATE OF CHARGE FOLIO N0./CHECK NO,
ACCOUNT NO. 10/2/2016 1361256 A
VS
-- AUTHORIZATION INITIAL
CARD MEMBER NAME
HECK, NANCY 027017
ESTABLISHMENT NO.&LOCATION ESTIIDEISIIMENT AGREES TO TRANSMIT TO WO HOLDER FOR PAYMENT PURCHASES&SERVICES
TAXES
TIPS&MISC.
_ _ IiRivT
CARD MEMBER'S SIGNATURE TOTAL AMOUNT ('.n.n.l"NucntL:as
-1,797.40
MFRCIIANDISE AND/OR SERVICES PURCHASED ON THIS CARD SHALL NOT RE RESOLD OR RETURNED FORA CASH REFUND. PAYMENT DUE UPON RECEIPT
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
NANCY HECK ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IN SUM OF$ 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.
$390.00 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Community Relations Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
EXPENSE 43-430.04 $390.00 1 hereby certify that the attached invoice(s),or 10/3/16 EXPENSE $390.00
REPORT REPORT
1203 101 bill(s)is(are)true and correct and that the 1203 101
materials or services itemized thereon for
which charge is made were ordered and
received except
Wednesday,October 05,2016
D
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
of
G�S4 W NCA24,
mea. Rvi�
i
CITY OF CARMEL. Expense Report (required for all travel expenses)
EXHIBIT A
EMPLOYEE NAME: _Na17CJ/ Heck DEPARTURE DATE: / (D TIME: // : . S- AMS/PM
DEPARTMENT: Community Relations & Economic Development__ RETURN DATE: /v Q z /6 TIME:
REASON FOR TRAVEL: IMLA Conference DESTINATION CITY: / San Diego, CA
EXPENSES ARE FOR(check all that apply):TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM X
Transportation Gas/Tolls/ Meals
Date Parkin Lodging Misc. Total
Air-fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
9/27/16 $27.63 $404.48 $65.00 $497.11
9/28/16 $10.35 $348.23 $65.00 $423.5.8
9/29/16 $348.23 $65.00 $413.23
9/30/16 $16.68 $348.23 $65.00 $429'.91
10/1/16 $21.51 $348.23 $65:00 $434474
10/2/16 $65.00 $65.00
$0.00
$0.00
$0.00
$0.00
$0.00
$00®
$0:00
$0.00
$0.00
$0.00
$0;00
$0:00
$0.00
$0.00
0:00
Total, $0:00 $0.001 : ,$76.171 $0.001 $1,797.401 $0.00 $0.00 $0.00 $0.00 $390.00 $0.00
DIRECTOR'S STATEM
EN
T:
I hereby
/affirm that all expenses listed conform to the City's travel policy and are within my departments appropriated budget.
Director Signature: Date: 10/J //1 6
City of Carmel Form#ER06 Revision Date 10/3/2016 Page 1
For advance payments, claim form must be submitted ten (10) business days in advance of travel.
Claim will not be processed without the following documentation:
1) Conference or course registration form, if applicable
2) Travel itinerary or car rental agreement, if applicable
3) Original itemized receipts for all expenses (or affidavits if appropriate), except for meal per diems (which require hotel receipt)
Prorated meal allowance:
For travel that commences before 1:00 p.m..(flight departure time, if traveling by air), $50 for in-state travel and $65 for out-of-state travel
For travel that commences after 1:00 p.m. (flight departure time, if traveling by air), $25 for in-state travel and$32.50 for out-of-state travel
For travel that ends before 1:00 p.m. (flight arrival time, if traveling by air), $25 for in-state travel and $32.50 for out-of-state travel
For travel that ends after 1:00 p.m. (flight arrival time, if traveling by air), $50 for in-state travel and $65 for out-of-state travel
EMPLOYEE ACKNOWLEDGEMENT OF MEAL ADVANCE AND OBLIGATION TO DOCUMENT EXPENDITURES:
I hereby acknowledge receipt of$ , such funds being advanced to me by the City of Carmel solely for the purpose of purchasing meals
while traveling to participate in official business for the City. I accept responsibility for these funds and agree to repay them if lost or stolen.
I understand that within ten (10) business days of my return (as stated on opposite side), I am responsible to:
1) Submit original itemized receipts to the office of the Clerk-Treasurer documenting all meal expenditures; and
2) Return all unused funds to the office of the Clerk-Treasurer
I further understand that failure to provide the required documentation shall result in the total amount of the advance being deducted from the first
paycheck issued more than 30 days after the date of my return. Failure to return unused funds will result in the amount of the unused funds (total
advance minus documented expenditures) being deducted from the first paycheck issued more than 30 days after the date of my return.
Employee Signature: Date:
City of Carmel Form#ERO6 Revision Date 10/3/2016 Page 2
wisiau i® u Der misers-my i rips
FREE RIDES
Filter Trips
MY TRIPS
Pickup Driver Fare Car City Payment
Nancy Method
Your profile 33 10/01/16 WILLIAM $12.37 uberX San Diego ....
5916
Add Credit Card
Verify Mobile 10/01/16 Jorge $9.14 uberX San Diego ....
Verifv Email 5916
My Trps 09/30/16 Ronnie $8.10 uberX San Diego ....
Profile 5916
Payment 09/30/16 GELASIO $8.58 uberX San Diego 0000
5916
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Log Out 09/28/16 Pablo $10.35 uberX San Diego
5916
Lost
something? 1> 09/27/16 bernard 127-63 UberBLACK San Diego ....
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HILTON SAN DIEGO BAYFRONT
One Park Boulevard I San Diego,CA 92-101Hilton T: 619 564 3333 1 F: 619 3214316
SAN DIEGO BAYFRONT W:hiltOn,COrn
NAIVE AND ADDRESS:
-IECK• NANCY Room: 2359/Q2V
Arrival Date: 9/27/2016 4:33:00 PM
Departure Date: 10/2/2016'11:35:00 AM
Adult/Child: 2/0
JNITED STATES OF AMERICA Room Rate: 359.00
Rate Plan: 2G
HI-1#
AL:
Car:
Confirmation Number:32752006'19
10/2/2016
DArr DESCRIPTION ID REF.NO CHARGES CREDITS BALANCE
I-IILTON
9/27/2016 GUEST ROOM ACOHEN1 8483534 $359.00 HHONORS
9/27/2016 TRANSIENT ACOHENI 8483534 $37.70
OCCUPANCY TAX
9/27/2016 SD TMD ASSESSMENT ACOHEN1 8483534 $7.18
9/27/2016 CA TOURISM FEE ACOHENI 8483534 $0.60
9/28/2016 GUEST ROOM ACOHEN1 8486305 $309.00 ::-4,t
9/28/2016 TRANSIENT ACOHENI 8486306 $32.45
OCCUPANCY TAX
9/28/2016 SD TMD ASSESSMENT ACOHENI 8486305 $6.18 (:ONR,i�
9/28/2016 CA TOURISM FEE ACOHENI 8486305 $0.60
9/29/2016 GUEST ROOM ABELL 8488716 $309.00
9/29/2016 TRANSIENT ABELL 8488716 $32.45
OCCUPANCY TAX i•{'s±t<}rz
9/29/2016 SO TMD ASSESSMENT ABELL 8488716 $6.18
9/29/2016 CA TOURISM FEE ABELL 8488716 $0.60
9/30/2016 GUEST ROOM ABELL 8491307 $309.00
9/30/2016 TRANSIENT ABELL 8491307 $32.45
D:;::nu i ris
OCCUPANCY TAX
9/30/2016 SO TMD ASSESSMENT ABELL 8491307 $6.18
9/30/2016 CA TOURISM FEE ABELL 8491307 $0.60
10/1/2016 GUEST ROOM ABELL 8493943 $309.00
10/1/2016 TRANSIENT ABELL 8493943 $32.45
OCCUPANCY TAX
10/1/2016 SD TMD ASSESSMENT ABELL 8493943 $6.18
10/1/2016 CA TOURISM FEE ABELL 8493943 $0.60
��an:nly:Ent.
ACCOUNT NO DATE OF CHARGE FOLIO NO•/CHEO(NO.
VS 10/2/2016 1361256 A
INITIAL
:.ARD MEMBLAUTHORIZATIONR NAME
HECK. NANCY 027017
!.SIABLISHMENTNO &LOCATION ELTMISRWNTMREES TO TF- TO CMOHOMER FOR PAYMM PURCHASES&SERVICES
lQM
TAXES
TIPS&MISC.
tiIsan
CARD MEMBER'S SIGNATURE TOTAL AMOUNT ,mnlVoc.nsn:;�
-1,797.40
Mt RE:I IANDISF.AND/OR 5FRVICES PURCHASED ON THIS CARD SHALL NOT BE RESOLD OR RETURNED FOR A CASI4 REFUND. PAYMENT DUE UPON RECEIPT
HILTON SAN DIEGO BAYFRONT
One Park Boulevard I San Diego,CA 92101
Hl'Ito Ri, T: 619 564 3333 1 F: 619 3214316
SAN DIEGO BAYFRONT W:hilton.corn
NAME AND ADDRESS:
HECK, NANCY Room; 2359/Q2V
Arrival Date- 9/2712016 4:33:00 PM
Departure Date: 10/2/2016 11:35:00 AM
Adult/Child: 2/0
UNITED STATES OF AMERICA Room Rate: 359.00
Rate Plan: 243
HH#
AL:
Car:
Confirmation Number:3275200619
10/2/2016
DATF DESCRIPTION ID REF.NO CHARGES CREDITS
BALANCE
HILTON
10/2/2016 VS*5916 RVERDUZCO 8495521 ($1,797.40) HHONCIRS
—BALANCE— $0.00
EXPENSE REPORT SUMMARY
9/27/2016 9/28/2016 9/29/2016 9130/2016
ROOM AND TAX $404.48 $348.23 $348.23 $348.23
DAILY TOTAL $404.48 $348.23 $348.23 $348.23
EXPENSE REPORT SUMMARY
10/l/2016 STAY TOTAL
ROOM AND TAX $348.23 $1,797.40
DAILY TOTAL $348.23 $1,797.40
ACCOUNT NO. DATE OFCHARGE FOLIO NO./CHEO(No.
VS 10/2/2016 1361256 A
'ARD MEMBER NAME
AUTHORIZATION INITIAL
HECK, NANCY 027017
OTABLISHMENT NO.&LOCATION arAmISOWNT AGRUS TO TWWIT TOCMDROLDER 1011PAYMENT PURCHASES&SERVICES
TAXES
TIPS&MISC.
LARD MEMBER",SIGNATURE TOTAL AMOUNT 4-11"1
-1,797.40
.VF R(HANT)jSf AND/Oft S1 RVICfS PURCHASED ON THIS CARD SMALL NOT RE RESOLD OR RETURNED FORA CASH REFUND. PAYMENT DUE UPON'RECEIPT
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
NANCY HECK ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IN SUM OF$ 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.
$41.17 Payee
ON ACCOUNT OF APPROPRIATION FOR
Purchase Order#
Community Relations Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
RECEIPT 43-590.00 $41.17 1 hereby certify that the attached invoice(s),or 9/26/16 RECEIPT $41.17
1203 101 1203 101
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
Wednesday,October 05,2016
I 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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
i
1111itt Lb He rall.11 0.
161) :,armel Dr. '.�_'� H6a�i �� ��e�ta>ara€�t 0
1:
(317) 843-9900 160 E. Carmel Dr.
Da-l:(:: Se:)26'16 01 :19PM Carmel, IN 46032
Ca••cl 1'%/P(:!: V i:ia (317) 843-9900
Acct 4`: X;(1(XXXXXXIO(X5S116
Ca •ci Entry: EM"TED 145 am y D
Tars TyE:, : PIPCHASE ----------------------------------------
f Key: l I._00 K0849790 Tb 1 E;:/1 Chk 1257 Gist 3,
ria t :,od(::; 02:1819 SeP26'16 12:36PM
Chick: 12:17 ----------------------------------------
Table: E:2!1 1 L u i:,hix: Sal Lou 10.25
Si- +rE r: 14:1 Amy D 1 Fish Sand NO Bun 9.85
1 Miri TEnclerloin 8.75
2 W It E'r 0.00
Loi 1 DiEt Mt Dere 2.50
l..: _ �___l S.ittata1 31.35
___... - --- Tax 2.82
1.FR C 0F)y T 1ta.l 34 . 17
TFI1A,1'A K V CIl_I