319911 12/21/17 CITY OF CARMEL, INDIANA VENDOR: 365322
._ 6 "�1• ONE CIVIC SQUARE JOHN ADAMS- CHECK AMOUNT: $****...375.00*
?� CARMEL, INDIANA 46032 12638 ROYCE COURT CHECK NUMBER: 319911
9Mfrne'c�� CARMEL IN 46033 CHECK DATE: 12/21/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER- AMOUNT DESCRIPTION
1192 4343004 375.00 TRAVEL PER DIEMS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 365322 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
JOHN ADAMS IN SUM OF$ CITY OF CARMEL
12638 ROYCE COURT 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.
CARMEL, IN 46033
Payee
$375.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Dept of Community Service 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
Adams 43-430.04 $375.00 I hereby certify that the attached invoice(s),or 12/20/17 Adams PC Meetings Oct to Dec 2017 $375.00
1192 101 1192 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, December 20,2017
Mike Hollibaugh
Director
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 I :lassification if claim paid motor vehicle highway fund. Clerk-Trea
Per Diems 4th Quarter
Meeting Dates 10/3/2017 10/17/2017 11/9/2017 11/9/2017 11/21/2017 12/5/2017 12/19/2017 Total to
BZA HO&
Comm PC Executive Comm PC Comm-no RES PC
Oct-Dec tonight. Be Paid
Names
-7.5.00 $
Casati, Michael $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 300.00
Grabow, Brad $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 375.00
Kegley,Tom $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 300.00
Kestner, (Vick $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 450.00
Kirsh,Joshua $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 300.00
Lockwood, Dennis $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 450.00
Moehl,Tim $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 375.00
Potasnik,Alan $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 450.00
Westermeier,Susan $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 375.00
Kimball, Bruce yes yes yes yes no yes
Hollibaugh, Mike yes yes yes yes yes yes $3,750.00