185385 05/11/2010 o_CA� }F CITY OF CARMEL INDIANA VENDOR: 363329 Page 1 of 1
ONE CIVIC SQUARE KENT PAULIN
CARMEL, INDIANA 46032 C/O COMM CENTER CHECK AMOUNT: $185.76
CHECK NUMBER: 185385
CHECK DATE: 5/11/2410
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4343002 29.76 EXTERNAL TRAINING TRA
1115 4343004 156.00 TRAVEL PER DIEMS
�C'1�Q. R
CITY OF CARMEL Expense Report (required for all travel expenses)
EMPLOYEE NAME: @i✓ U DEPARTURE DATE: TIME: 7 ,0 0 PM
DEPARTMENT: _Communications RETURN DATE: �1. 9 0 TIME: 5� AM PP
REASON FOR TRAVEL: c Lo m DESTINATION CITY: v �L
EXPENSES ARE FOR (check ali that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM Zr
Transportation Gas/Tolls/ Meals
Date Parkin Lodging Misc. Total
Air -fare Car Rental Other 9 Breakfast Lunch Dinner Snacks Per Diem
4/27/10 $12.89 $12.89
4128/10 $6.15 $6.15
4129110 $3.72 $7.00 $10.72
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
0.00
Total $0.00 $0.00 $0.00 $0.001 $0.00 $3.721 $26.04 $100 $0.001 $0.00 $0.00
DIRECTOR'S STATEMENT: I her affirm that xpenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date:
City of Carmel Forrh ER06 ion Date 5/6/2010 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 $60 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 $30 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 $30 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 $60 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 ER06 Revision Date 5/6/2010 page 2
ROSTER LAW ENFORCEMENT TRAINING
Y STATE FORM 46167 (8 -93) y
PLEASE TYPE OR PRINT CLEARLY
PR VIOER OR INSTRUCTOR
TELEPHONE NUMBER
LOCATION OF TRAINNG C NTACT PERSON AT TRAINING SffE
COURSE TITLE
PRIMARY INSTRUCTOR J
SUCCESSFULLY COMPLETED INCOMPLETE FAILED F� OTHER
I AFFIRM THAT THE INFORMATION CONTAINED HEREIN IS COMPLETE AND ACCURATE TO THE BEST OF MMY KNOWLEDGE AND BEELIEF.
SIGNE PRINTED NAME Xf lJ ATE
TRAINING DATE(S) PROVIDER OR INSTRUCTOR COURSE NUMBER INSERVICE
MM DD- YY MM DD YY NUMBER CREDIT
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Prescribed by State Board of Accounts General Form No. 101 (1855)
MILEAGE CLAIM
DR.
TO
Governmental Unit)
9
i
On Account of Appropriation No. Al-a t c? for
(Offi Board. Department or Institution)
i
DATE FROM TO ODOMETER�READING" NATURE OF BUSINESS AUTO MILES MILEAGE
20_,!�'D Point Point Start Finish TRAVELED PER MILE
o -r.� 1304 Moa iw c a n d S. 41 A- Div e' yi7 O C ge o 0
L -M t f T'// 7 6'52
Auto License No. TOTALS 3 1 Z J O
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 1353, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
atlowing all just credits, and tha no part of the same has been paid.
Q
Date
I
3
4
Clmm No. Warrant No. I have examined the within claim and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority:
That it is apparently correct
incorrect
On Account of Appropriation No. for
Disbursing Officer
o m
Allowed .20 m
in the sum of o
@a�
ID
0 rn
'U CD
D
($o=d OI Ca mmic m i `mo
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FaM
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n
0
0
CI c`CD
0 m
(o
(OiHctal Title)
h
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m a
VOUCHER NO. WARRANT NO.
ALLOWED 20
Kent Paulin
IN SUM OF
1300 Woodpond Roundabout
Carmel, In 46033
$185.76
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# I Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1115 43- 430.02 $29.76 1 hereby certify that the attached invoice(s), or
1115 43- 430.04 $156.00
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
Thursday, May 06, 2010
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
05/06/10 $29.76
05/06/10 $156.00
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
2d
Clerk- Treasurer