156720 02/21/2008 CITY OF CARMEL, INDIANA VENDOR: 357812 Page 1 of 1
o� ONE CIVIC SQUARE WILLIAM MISER
CARMEL, INDIANA 46032 5208 ROLAND DRIVE CHECK AMOUNT: $914.65
INDIANAPOLIS IN 46228 CHECK NUMBER: 156720
CHECK DATE: 2/21/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4343002 914.65 EXTERNAL TRAINING TRA
V Q PATNF,I(f ��C
CITY OF CARMEL Expense Report (required for all travel expenses)
INDIAN?
EMPLOYEE NAME: DEPARTURE DATE: 1� Z? TIME: ;3p AM/ M
DEPARTMENT: r_> 6 C.S RETURN DATE: (may ZpdlB TIME: AM
REASON FOR TRAVEL: P->u ;(d,g C.odt G�a.SS DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
Transportation Gas /Tolls/ Meals
Date Parkin Lodging Misc. Total
Air -fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
1/27/08 $20.00 $81.00 $30.00 taxi tip $131.00
1/28/08 $81.00 $60.00 $141.00
1/29/08 $81.00 1 $60.00 $141.00
1/30/08 $81.00 $60.00 $141.00
1/31/08 $20.00 $57.61 $60.00 taxi tip $137.61
2/1/08 $115.53 $47.51 $60.00 $223.04
$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 i $0.00 $115.53 $40.001 $47.51 $381.61 $0.001 $0.001 $0.00 $0.00 $330.001 $0.00
DIRECTOR'S STATEME hereb affirm hat xpens listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date: a
City of Carmel Form ER06 Revision Date 2/5/2008 Page 1
UW- MADISON REGISTRATION CONFIRMATION INVOICE This portion is for your records
l Bring to Seminar
Pyle Center, 702 Langdon Street, Madison, WI 53706 -1487
THE UNIVSITY 12/17/07
WISCONSIN Registration Inquiries: Phone (608) 262 -1299
M A D I S O N Invoice No.
1037564
Attendee o. FID 39- 1805963
Reg. ID WILLIAM CRAIG MISER
Order W08A861901J264
1037564
WILLIAM CRAIG MISER BUILDING INSPECTOR
CARMEL DEPT. OF COMM. SERVICES
ONE CIVIC SQUARE
CARMEL, IN 46032
cmiser @carmel.in.gov Ph# 317- 571 -2289 01 *395871
BUILDING INSPECTION
JANUARY 28 31, 2008
REGISTRATION TIME: 07:45am MONDAY
PYLE CENTER Total Fee 1095.00
702 LANGDON STREET Payment Rec'd 1095 .00
MADISON, WI 53706 Balance Due 0 .00
Payment Method
CKC K/154790
DAVE PETERSON PROGRAM DIRECTOR
RM BLOCKS LOWELL CTR 608- 256 2621 /CAMPUS INN 800 589 -6285
lf:totabfee;has,not been paid.please remit immediately to: University of Wisconsin Extension,
Box 78047; Milwaukee, •WI 53278 -0047 (Make checks payable to University of Wisconsin.)
FEE 1NORKSHOP SELECTIONS
1037564 COURSE FEE 1095.00
This program is offered by UW- Madison in cooperation with UW- Extension. Thank you for your registration.
F Send this portion with payment
Invoice No. 1037564
REMITTANCE STUB RECEIPT
01 *395871
THE UNIVERSITY Total Fee
Enclosed is my payment for the following UW- Madison program: 1095.00
WISCONSIN Payment Rec'd. 1095.00
M A D 1 5 0 N Balance Due
0.00
WILLIAM CRAIG MISER Payment Method
BUILDING INSPECTION Cash
JANUARY 28 31, 2008
1037564 W08A861901J264 NO REMITTANCE REQUIRED Check
P. O. No.
Credit Card VISA MC ❑AMEX
Please make checks payable to University of Wisconsin
Number Exp. Date
Mail payment to: University of Wisconsin Extension
Box 78047 Cardholder Name
Milwaukee, WI 53278 -0047
sika/5.2002 Signature
�I.
Building Inspection
January 28 -31, 2008 in Madison, Wisconsin
10:00 Understanding and Inspecting
Course outline Tuesday, January 29
Concrete
4 8:00 Inspecting Masonry (continued)
Physical characteristics of concrete
Monday, January 28 Roger Axel Additives and their purposes
7:45 Registration 9:00 Inspecting Conventional Wood Basic concrete tests
Increase Your Inspection The Pyle Center Framing Concrete reinforcing
Concrete placement and curing
702 Langdon Street Foundation anchorage P 9
Efficiency and Madison, Wisconsin Beams and headers Hot and cold weather concreting
8:00 Welcome and Overview Ceiling joist,and rafter connections Typical concrete construction
Effectiveness Draft stopping and fire blocking problems
Dave Peterson Braced walls David Bohnhoff and Ronald L. Lynn
13,ei�lrli�n la.tipecti.nn, presents practical 1'
Program Director
Method- that will improve your efliciency
University of Wisconsin- Madison Ro Axel 12:00 Lunch
Mid effectiveness in the application and 11:30 Lunch 1:00 Inspecting Steel Construction
enforcenlent of our building code durin r 8:15 Improving Field Inspection
y f, k. Procedures 12:30 Structural Fundamentals for •Basics of steel framing stresses
field inspections, including specific ways Buildi Inspectors Structural steel properties and
to minimize or �nizational liability and Developing a consistent field 9 p p p
g� Y
increase r success as You use le cal )ro- inspection procedure •Basic structural stresses shapes
You]'
y k I •Preparing for the inspection before tension and compression •Welded connections
cedures to enforce the code. You will learn you leave the office shear and bending Bolted connections
how to develop consistent procedures and e Communicating corrections and buckling Fire resistance considerations
checklists to meet today's demand for high gaining compliance Building loads and load paths Ronald L. Lynn
quality inspection in less time. Developing your own checklists Resisting horizontal loads 3:00 Special Inspection Programs
Example inspection checklists bracing Purpose and intent
Roger Axel diaphragms and shear walls Work requiring special inspections
Boost Y our Technical
David Bohnhoff How to qualify special 0:30 Fire Safety Inspection Issues q fi' inspectors
p P
Competence and Type of construction 2:30 Inspecting Foundations Responsibilities of special
Confidence Location on the property Types and bearing capacities inspectors
Allowable height and area Dealing with soil problems Ronald L. Lynn
This coarse presents the underlying tech- Fire resistance -rated construction Drainage and waterproofing 5:00 Adjourn for the Day
nical hasis fur huilding code. provisions, Interior finish materials Designing for lateral loads
indiding basic st;ructur,al engineering Means of egress defined David Bohnhoff Thursday, January 31
concepts for Building construction. Special Occupant loads 5:00 Adjourn for the Day
attention is paid to important fire safety Requirements for egress travel path 8 :00 Liability Concerns and Legal
Travel distance, exits and ref Procedures
code provi�aonti, such as occupancy loads, 9 Wednesday, January 30
fire resist ante rata d construction end Donald R. Mercer Basic legal concepts and definitions
8:00 Understanding and Inspecting •Legal basis of the building code
means of ct,r c,ss.'I hc, Cour also delves into 12:00 Lunch
the technical details of soils, foundations, Soils •Powers /duties of the building
1:00 Fire Safety Inspection Issues Types and properties of soils official
wood, concrete, masonry, and steel construe- (continued) Basic soils tests Areas of possible liability concern
tion. By improving your technical under- Donald R. Mercer Compaction methods and tests Ronald L. Lynn
standing at this course, you will be, able to 4:00 Inspecting Masonry Recognizing soil hazards 9 :30 Legal Remedies Sought by
make more informed inspection decisions Properties of masonry -faulting and fissuring Building Officials
and comnrunicat:e them more clearly to Wall assemblies and reinforcement expansion Summary action, remediation and
builders, designers, and owners. Masonry/non- masonry connections heaving abatement
Masonry fireplaces collapsing Importance of records and
Roger Axel ground water related hazards procedures
Who Sho uld Attend
5:00 Adjourn for the Day David Bohnhoff and Ronald L. Lynn Building inspector as witness
New and experienced building inspectors, Ronald L. Lynn
plans examiners, building officials, and oth
ers with building inspection responsibilities [Please note: The daily schedule includes refreshments prior to the start of the 11:30 Final Adjournment
Will benelit, from this course. course, morning and afternoon breaks, and lunch at noon (except on Thursday).
e-
6 4 w5flCcn rner
In aftd CoAf-ar "ec Ce tiler
Express Check -out Folio
Reservation Number: 171556
CRAIG MISER Room Number 404
TransactionDate Description TotalCost
1/27/2008 Nightly Chg. Room 404 $81.00
1/28/2008 Nightly Chg. Room 404 $81.00
1/29/2008 Nightly Chg. Room 404 $81.00
1/30/2008 Nightly Chg. Room 404 $81.00
1/31/2008 Guest Payment MC 4501 324.00
Total Balance $0.00
I
Thank you for staying with us at The Lowell Center. We hope your stay with us was a pleasant one. Our records indicate
;you will be departing today. For your convenience, we have made your departure easier with our Express Checkout.
Please review your bill for accuracy. If you do not have any questions, you can drop your key at the front desk.
.Checkout is at 11 a. m. Breakfast is 6:30 -8:30 a. m. on weekdays and 7:30 -9:30 a. m. on weekends on the B level.
The Lowell Center 610 Langdon St Madison, WI 53703 -1195 (608) 256 -2621 conferencing.uwex.edu
i
3841 E. Washington Ave Date 2/1/2008 06:44:20
lt,1P Madison, WI 53704
l oom Tel: (608) 244 -2481 Folio number 0000031263
Arrival date 1/31/2008
Fax:(608) 244 -0383 Departure date 2/1/2008
Room type 2 doubles n/s
Room number 110
WILLIAM MISER
5208 ROLAND
INDIANAPOLIS IN 46228
United States
Howard Johnson Madison, Madison
Date Description Supplement Qty. Price Amount
1/31/2008 Distressed Passenger 1 49.00 49.00
State County Tax 2.70
Lodging Tax 4.41
1131/2008 Safe Limited Warranty 1 1.50 1.50
2/1/2008 -57.61
Transaction: 2008020106:44
Authorisation: 055012
Merchant:
Total net 50.50
State County Tax 2.70
Lodg ing T 4.41
Total gross 57.61
Pai -57.61
Balance 0.00
We thank you for your visit and we hope to see you again soon.
If you were a member of the TRIP Rewards program, you could have earned valuable points for this stay. To become a
member visit us at triprewards.com or call 1- 800 -FOR -TRIP.
I agree that my liability for this bill is not waived and I agree to be held personally liable in theevent that the indicated
person, company or association fails to pay for any or part of the full amount of these charges and I shall be responsible
for any loss or damage to the premises or its contents.
Signature:
This Facility Is Independently Owned And Operated Under A License Agreement With Howard Johnson.
Please contact the Manager about any issues with your stay. Howard Johnson or affiliates may contact you about goods and services unless you call
877 227 -3557 or write to: Opt Out/Privacy, Wyndham Worldwide Hotel Group, Inc., 1 Sylvan Way, Parsippany, NJ 07054 to opt out. View our
Howard Johnson website about privacy.
B Midwest Rental Services, Inc. PAIGE 1 RA
U91 t d /b /a BUDGET OF MDISON 02%01/08; N'o5�,�29;0 ®H 11 4000 INTERNATIONAL LN *AIRPORT
MADISON, WISCONSIN 53704 VEHICLE 8908616 MVA
NUMBER
Car Truck Rental (608)249 -5544
LICENSE IL8085591
AN INDEPENDENTLY OWNED BUSINESS CO PY COLOR /MAKE GREY /PT
RENTER MISER,WILLIAM NONE MODEL PT CR MVA
5208 ROLAND DR 09/26/55 VEHICLE NO DAMAGE
INDIANAPOLIS, IN 46228 CONDITION
(317)254-1055 WHEN RENTED
TOWN OF JAMESTOWN IND (765)635 -6331 DATE IN
TIME
License 1050050285 IN 09/26/12 LOCATION OUT 02/01/08 09:00 AP
ADDITIONAL NONE MILEAGE IN
RENTER
OUT 000243
DRIVEN
License FUEL GAUGE IN: OUT: FULL
DUE BACK 02/02/08 09: 00 0 RATES DO NOT INCLUDE :FUEL
A REFUELING CHARGE WILL APPLY.: :IF VEHICLE IS RETURNED WITH :LESS FUEL THAN WHEN RENTED.
LOCATION IND INDIANAPOLIS MILES UNLIMITED MILEAGE NO CHARGE
RENTER WILL BE PROSECUTED IF VEHICLE IS NOT RETURNED WHEN DUE BACK.
IF VEHICLE IS RETURNED TO OTHER THAN THE RENTING LOCATION, AN INTERCITY HOURS 47.50 H r
DROP FEE MAY BE CHARGED. DAYS 1 95.00 Day 95.00
RENTER MUST REPORT ALL ACCIDENTS, NOTIFY THE POLICE AND COMPLETE AN y
ACCIDENT REPORT. RENTER IS RESPONSIBLE FOR PARKING AND TRAFFIC VIOLATIONS. WEEKS 380.00 /Wk. 0
RENTER IS RESPONSIBLE FOR THE COST OF KEY REPLACEMENT AND ANY
ASSOCIATED CHARGES IF KEYS ARE LOST. WEEKS 380.00 0
C�ont OW IND, IN DAILY /WEEKLY UNLIMITED COMPACT
Method t RATE IS BASED ON 24 HOUR DAY, ONE DAY MINIMUM.
Payme
LOSS DAMAGE WAIVER (LDW): WAIVER IS OPTIONAL ESTIMATED TIME CHG 95.00
I have read and signed your LDW Disclosure.
I decline LDW at the rate shown and I will be Renter Responsibility: FULL VAL
responsible for any loss or damage up to DROP FEE
the amount of the responsibility shown. I DECLINE(: LDW 16.99 /D
SUPPLEMENTAL LIABILITY INSURANCE (SLI):
I have read and understand your SLI brochure.
I decline SLI at rate shown to provide added
liability insurance coverage of up to $1,000,000. 1 DECLINE X SLI 12.95 /D
PERSONAL ACCIDENT AND EFFECTS INSURANCE (PAE):
I have read and understand your PAE brochure.
I decline PAE coverage for accidental loss of life,
medical coverage and loss or damage to personal property. I DECLINE >PAE 5.95 /D
NO ADDITIONAL DRIVERS ALLOWED:
I UNDERSTAND NO OTHER DRIVERS ARE AUTHORIZED. I AGREE X;
REFUELING: I agree to refill the gas tank iust before returning
the vehicle or to pay the refueling cha per g allon shown. i AGREE REFUEL 6.99 /Gal
9 9 p 9
If I traveled 75 miles or less upon return of the vehicle I must present a GAS RECEIPT showing that
I refueled within 5 miles of the Budget office or I will pay Budget a refueling fee of $10.50 plus tax.
ADDITIONAL CONDITIONS: our BY: N BY: TAXABLE SUBTOTAL 95.00
Lisa SALES TAX 10.5 9.98
CONC.RECOV.FEE 11.1 10.55
VEH.LIC.FEE .79 0.79
GLASS,TIRES NOT COVERED WITH LDW
CUSTOMER RESPONSIBLE:ALL DAMAGE
UNTIL INSPECTED BY A BUDGET REP.
BEFORE I DRIVE THE RENTAL VEHICLE, I AGREE TO INSPECT IT FOR DAMAGE. ESTI Ci HARG ES 116.32
IF DAMAGED, I WILL REQUEST YOU TO INDICATE THAT ON THIS RENTAL AGREEMENT
BEFORE I LEAVE THE RENTAL OFFICE. ESTIMATE IS BASED ON ABOVE DUE BACK
I HAVE READ THE TERMS AND CONDITIONS ON RENTAL DOCUMENT JACKET AND CREDIT REFUND DATE, TIME AND LOCATION, EXCLUSIVE
ON THIS PAGE OF THE RENTAL AGREEMENT AND AGREE THERETO.
I AUTHORIZE BUDGET.RENT A CAR TO PROCESS A CREDIT CARD VOUCHER, IF ANY, CASH REFUND OF EXCESS MILEAGE, AND REFUELING IF
FOR CHARGES INCURRED HEREUNDER, TO USE THIS SIGNED AGREEMENT IN LIEU OF CHECK REFUND FUEL IS NOT PREPAID.
A CREDIT CARD VOUCHER, AND AS CARDMEMBER, I AGREE TO PERFORM THE
OBLIGATIONS SET FORTH BY MY CARDMEMBER'S AGREEMENT WITH THE ISSUER. RENTER'S
INITIALS
RENTER'S
SIGNATURE X SIGNATURE ON FILE :'CLOS'.ED CONTRACT :.SUBJECT TO FINAL A':UDIT
Budget Rent A Car System, Inc. .I
Itl' 4220 TNTFRNATTrWAI I ANF MADTOM.I1T.5.37A6_ IS ?AF4 1 4A
1)RnIRNrf RA IIMIIMFNT S:IWR174 RFNTFD: 611FFRAA /OIQW11? AT! MADTq W. WT APT OMIF! FAA—PO—r,544 4AA94A I,
fAR# A q A A F 1 F f,RP r RFTIiRNe RIFFRN11/171A Air BATH qT /TNDY_ TN RATFe M /f. TTMF: A DY R HR 'B
DIIF TNi OarFFRAAIRWIR AT! TNDY ARtT. IN MIN 1 TRAY
MT rUTT: PQ MT IN! F!? VOI MT fd W
TfiTAI MTI Fq DRTUFN: 1701 ********flPTTM1Al to HR Ia .11_0 I 'WHO
PIATF# TI A0R9F#gI FIiFI 11I1Te A/A A BY A 99.M
fRY F'HRY PTrR OR FIIFI IN! A/A I11W: iF.gq /iIAY DFf3 TNFD A lit fa 3Aa_M
r.
PAF: 5.95 /DAY TWO TNFii A wi fd
MFTWIn flF PAYMFNTe DTRFfT FqP: IINAU411 MIN tDY /M /t: qS.M
DR1UFRq I Tf# IS11 YYY55gl ql T: IF.g9 /DAY Uri TNFD F1TFI gFRUIr.Fe A31 /Ml I!
RFMQRRge RII /M.gW4PgM 4. qqq /HAI
1
RA MII I +IFNT .9.?J VR74 qi IRTATAi q5. WA
TAY t A. SthA% q. qA
#I I. i0it� FFF Ia55
WITAI f. WF.q i 5. 51
Wild WT DI iF DT 1 1R t 15.5.?
TAY TNfi IIDFq 3% RFNTA) PAR FFF•f�#3
#UFHTfi F 1 Tr:FNgF FFF f 7!
**rmt.F.rgTfw RFTnww FFF
t
121Tq 11.U11I TAM
RA fW FII F AM—SA4 —WSW
1
y
WRTTt' F. S Pl riTtfFr iIi1TTrFq _NflTT(Fq- NilTTrFq MnTTf.FS N;1Tlr.FR
z" "T11F AI#'HNT THAT APPFARq IN "ANIINT THIF" WAR RFFN "^T HAUF READ AND ARRFF Ttl TFdF TFRMq AND fflNDTTTfINq
I' All I FD Tr! Yniff? ADDRFgq. CJQIN rW THIS RFWTAI TH1rl MFNT AND flN THE gFPARATF
f.I WR OF SIIR.TFfT TfI AIIDTT AND f.HANAF IF ANY RFNTAI W.111tFNT .TW'YFT TiR TUFRFD Til MF WITH THP;
FRRflRq ARF F111IND. DfU IMFNT F
��THAN); WH I Fi1R RENT TNi; FRnN PHOWT. i I
MINTM111H f.HARRF iq i DAY W4 HRq) PI IS MTIFAf,F. Y !�,r� r RFNTAI #5.iA984 174
AA"F1TFI gFRUTf.Fq AW1 IF CAR Tq RFTIIRNFD WITH I FS(; FPAR D RYi 41770 f1 flgFD AY! ?51019
FIIFI THAN WWFN RFNTFD.
3457 /Ag44 /RAAAP /i7: ?i /fl
4
I
Coy, Sue E
From: Debbie Tunstill Debbie. Tunstill @thetravelagentinc.com]
Sent: Monday, January 07, 2008 11:22 AM
To: Coy, Sue E
Subject: Confirmed flight for William Miser
SALES PERSON: A09DT ITINERARY /INVOICE NO. ITIN DATE: JAN 07
2008
ACCOUNT CPD L272ZO PAGE: 01
FOR:
MISER /WILLIAM
TO: CITY OF CARMEL CITY OF CARMEL- COMMUNITY
SERVICES
ONE CIVIC SQUARE 3RD FLOOR ATTN:SUE COY
CARMEL IN 46032 ONE CIVIC SQ
CARMEL IN 46032
27 JAN 08 SUNDAY MILES- 177 ELAPSED TIME- 1:15
AIR LV INDIANAPOLIS 430P AMERICAN FLT:4378 SPECIAL CL
CONFIRMED
AR CHICAGO /OHARE 445P NONSTOP FOOD TO PURCHASE
RESERVED SEATS 5A
AIRLINE CONFIRMATION:AA LMDITS
MILES- 109 ELAPSED TIME- :50
AIR LV CHICAGO /OHARE 545P AMERICAN FLT:4246 SPECIAL CL
CONFIRMED
AR MADISON 635P NONSTOP FOOD TO PURCHASE
RESERVED SEATS 7B
AIRLINE CONFIRMATION:AA LMDITS
31 JAN O8 THURSDAY MILES- 109 ELAPSED TIME- 1:00
AIR LV MADISON 405P AMERICAN FLT:3969 SPECIAL CL
CONFIRMED
AR CHICAGO /OHARE 505P NONSTOP
RESERVED SEATS 5B
AIRLINE CONFIRMATION:AA LMDITS
MILES- 177 ELAPSED TIME- 1:00
AIR LV CHICAGO /OHARE 605P AMERICAN FLT:4135 SPECIAL CL
CONFIRMED
AR INDIANAPOLIS 805P NONSTOP
RESERVED SEATS 5B
AIRLINE CONFIRMATION:AA LMDITS
1
TICKET IS COMPLETELY NONREFUNDABLE IF UNUSED. MAY CHANGE
ONLY PRIOR TO ORIGINAL TRAVEL DATE. FEES WILL APPLY.
THIS IS AN ELECTRONIC TICKET. PLEASE PRESENT PHOTO ID
AT CHECK IN WITH CONFIRMATION.
CONF AA LMDITS
*YOU MUST VERIFY ALL INFORMATION IS CORRECT. ONCE ISSUED
FEES AND PENALTIES EXIST FOR REISSUES REFUNDS AND CHANGES
FOR AFTER HOURS EXISTING RESERVATION EMERGENCY CALL
877 645 6373 CODE A09. A $15.00 PER CALL FEE WILL BE CHARGED.
A FEE OF 5PCT ON THE TOTAL COST APPLIES TO ALL CANCELLATIONS
FOR BOOKED TOURS CRUISES OR LAND HOTEL PACKAGES.
THE TRAVEL AGENT THANKS YOU -317 846 9619..DEBBIE WWW.TTA.TRAVEL
TICKET NUMBER /S:
MISER /WILLIAM 7157371662 CARD 315.00
ELECTRONIC
AIR TRANSPORTATION 253.95 TAX 61.05 TTL 315.00
PROCESSING FEE 35.00
SUB TOTAL 350.00
CREDIT CARD PAYMENT 350.00
TOTAL AMOUNT 0.00
2
i
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)) r
t o BCD I N. Cv 5
Total
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
VOUCHER NO. WARRANT NO.
&Cue( lae"r ALLOWED 20
J I-) IN SUM OF
G� QCs
ON ACCOUNT OF APPROPRIATION FOR
1J OC-5
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
a ly.105 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
c, o /20 0
na r
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund