186284 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 364131 Page 1 of 1
0 ONE CIVIC SQUARE BETH EARLYWINE
CARMEL, INDIANA 46032 4931 N KITLEY AVENUE CHECK AMOUNT: $404.65
INDIANAPOLIS IN 46226 CHECK NUMBER: 186284
CHECK DATE: 6/9/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4343002 175.00 EXTERNAL TRAINING TRA
1115 4343004 229.65 TRAVEL PER DIEMS
Prescribed by Stale Beard of Accounts General Form No. 30 (1955)
MILEAGE: CLAI TO DR.
(Governmental Unit)
On Account of Appropriation No. �Q Q for Z. 4,Q.
Ece, oard. Department or lnsticu; ion)
DATE FROM TO Ci
DOMETE.R READING" NATURE OF EUSINESS j AU MILES MILEAGE C
24 Point Point Start Finish f TRAVELED PER MILE
c t 3 tom► V.'i k'k I IV 5 P
5 /G11G�
Q 1 G 1 1 u i x e, �:1a t`c\ f'C: 1 c_c� 1 '�S 1�ti Co �4�5 II 1Z r CIE i
!1 Z(d iU 'C c I `1l� 13u i `t`i
U �?1 `Ll ;•_�r�e� `c J�.tiyJ� 4 r�LJC�c�s� I It3la.
CL3�sS 3 Z
5 l z S�i I o G i 5 t •5 k 1 lti i< i te e .—r i 1. S l-' fz vE� -1-G
57 1 0 c Z� L +k Lt 's '�;tl� �Y.c 1 I a35 I I` ru7 C S t
I
i
I
a
,I
Auto Li cens e No. TOTALS
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 legally due, after
allowing all just credits and that no part of the same has been paid.
Date
Claim No. Warrant No. I have exaaruned 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
Disbwsing Officer
o m
Allowed .20 cD o
t
in the sum of o
CD
CD 0- CD
ID
R
N N
CD
(Bca:d or Conunissim) R O
w
F=
a
C CD
0
C) (DD
Q
m oo
(D m
r 5
(Official Title)
CD
m o R
O
CD 0.
I
Dispatch software for law enforcement, sheriffs department, fire depar... Page 1 of 1
R
a�
r� O
MORE ADDITIONAL COURSES
Detail for Course 59
Start Date: 5/26/2010 8:00:00 AM
End Date: 5/28/2010 5:00:00 PM
Site: AMR Evansville
Location: Evansville, IN
Address: 950 E. Virginia St,
City: Evansville
State: IN
Postal Code: 47711
Hotel Name: Quality Inn Evansville
Hotel Phone 812- 471 -3414
Address: 8015 E. Division St.
City: Evansville
State: IN
Postal Code: 47715
Register for this Course!
BACK TO .LIST
.pi approved
G 2010 PRIORITY DISPATCH CORP. HOME LEGAL TERMS OF USE I PE
https: /courses.prioritydispatch. net/ CourseDetail .asox ?courseNum= 59 4/2/2010
VOUCHER NO. WARRANT N
ALLOWED 20
Beth Earlywine
IN SUM OF
4931 N. Kitley Avenue
Indianapolis, IN 46226
$229.65
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1115 43- 430.04 $229.65 1 hereby certify that the attached invoice(s), or
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, June 02, 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))
06/01/10 $229 -65
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
Clerk- Treasurer
G Q rtTUek s Fl
CITY OF CARMEL Expense Report (required for all travel expenses)
Elizabeth Earlywine 5/25/2010 1300 AM M
Carmel Clay Communications Center 5/28/2010 1900 AM M
LOCATION
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT x
Transportation Gas /Tolls/ Meals
Date Parking Misc. Total
Air -fare Car Rental Other 9 Breakfast Lunch Dinner Snacks Per Diem
5/25110 $26 0 $25.00 $51.00
5126110 .00 $50.00 $76.00
5/27/10 50 00 $50.00
5128/10 $50.00 $50.00
$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 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $175.00 $0.00
DIRECTOR'S STATEMENT: I r that all ex nses t conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date:
City of Carmel Forin ER06 Revision date 6/5/2010 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 !ravel 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 Forin ER0.6 Revision Date 615!2010 Page 2
Elizabeth Earlywine
Affidavit of Expenses
I purchased gas for the trip to Evansville for EMD class on May 25, 2010. The total of
the purchase was $26.00 at the Speedway Station 46 /Shadeland Ave. On May 26, 2010 1
again purchased gas at MotoMart in Evansville, IN. The total for that purchase was also
$26.00. 1 attest that this is true and accurate information.
Signed
Date
Dispatch software for law enforcement, sheriffs department, fire depar... Page 1 of 1
P �Z
0 f
MORE ADDITIONAL. COURSES
Detail for Course 59
Stare i Date: 5/26/2010 8:00:00 AM
End Date: 5/28/2010 5:00:00 PM
Site: AMR Evansville
Location: Evansville, IN
Address: 950 E. Virginia St.
City: Evansville
State: IN
Postal Code: 47711
Hotel Name: Quality Inn Evansville
Hotel Phone 812 -471 -3414
Address: 8015 E. Division St.
City: Evansville
State: IN
Postal Code: 47715
Register for this Course?
BACK TO LIST
MWE" appraved
VOUCHER NO. WARRANT N
Beth Earlywine ALLOWED 20
IN SUM OF
4931 N. Kitley Avenue
Indianapolis, IN 46226
00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# 1 Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1115 43- 430.02 —s-27roo I hereby certify that the attached invoice(s), or
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
Monday, June 07, 2010
�I�.r•
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))
06107, I 1 $227.00
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
20
Clerk- Treasurer