166732 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 353648 Page 1 of 1
ONE CIVIC SQUARE INDIANA STATE MUSEUM
CARMEL, INDIANA 46032 650 W WASHINGTON ST CHECK AMOUNT: $51.00
INDIANAPOLIS IN 46204
CHECK NUMBER: 166732
CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4343007 105269 51.00 FIELD TRIPS
Parks &Recreation CHECK REQUEST
NOV 2 4 7008 1
Date. 6 w
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Check payable to I I'1G� i ►1C1 .�I (/�+e i�'�((S�'((
Name:
Address:(
City, State, Zip U\ l
Mail check to payee turn check to requestor
Check Amount `m �C Date Required:
Check needed for \(�_Q
To be paid from
PO (if applicable)
Budget account GL
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Budget Line Description \2
Supporting documentation or receipt(s) MUST be attached.
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Requested by (print): �J.
Requested by (signature):
Approved by (signature of Division Manager):
on this date
Form revised 1 -21 -08
1
INDIANA STATE MUSEUM
NOV 2 4 ?008
GUEST SERVICES
650 W. Washington Street'
Indianapolis, IN 46204
317.232.1637
RESERVATION CONFIRMATION PACE 2 OF 2
INVOICE
CUSTOMER: ORDER NUMBER: ARRIVAL DATE TIME:
CARMEL CLAY PARKS AND RECREATION 105269 12/19/2008 2:10 PM
VALESKA SIMMONS LUNCH
1235 CENTRAL PARK E DR NO LUNCHR RESERVED
CARMEL, IN 46032 AGENT'S NAME:
ERIC
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10 POLAR GROUP ADULT 12.50 125,00
POLAR EXPRESS 3D 12/19/2008 2:40 PM
110 POLAR GROUP CHILD 6.00 660.00
POLAR EXPRES 3D 12/19/2008 2 :4 PM
TOTAL 785.00
PAYMENT 0.00
BALANCE DUE 785.00
CSI FT CEP7 FI CATE 734X
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ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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. 19630
353648 Indiana State Museum Terms
650 W Washington Street
Indianapolis, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/19/08 105269 Imax /Polar Express /Forest Dale Elementa 12/19/08 51.00
Total 51.00
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
Voucher No. Warrant No.
353648 Indiana State Museum Allowed 20
650 W Washington Street
Indianapolis, IN 46204
In Sum of$
51.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 105269 4343007 51.00 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
25 -Nov 2008
Signature
51.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I In d i a In a S t a t e Tk
NOV 242 11
U Um T
650 West Washington Street Indianapolis IN 46204
Phone 317.232.1637. Fax 317.234.2489
www.indianamuseum.org
To: LINDA From: ISM
Fax: 317.573.5254 Pages: 2
Phone: Dace: November 2 0,2 008
Note:
Payment is due upon arrival $734 in payment of a Gift Certificate
Amount due $51.00
Carlotta Myers
Guest Services Supervisor
Indiana State Museum and Historic Sites
650 W Washington 5treet
Indianapolis, Indiana
46204
317.690.5855
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Date 12119/08 Arrival Time A'ROtM1?'T,31(Y
Contact VALESKA SIMMONS Gradc YOUTH
School or Organization CARMEL CLAY PARKS RECREATION
Address 1235 CENTRAL PARK E DR
City, State, Zip CARMEL, IN 46032
Phone 317.258.6504 Email NOT GIVEN
Fax 317.573.5254 Want info about events emailed? Y/N N
Students with disabilities? Y/N N How many what kind?
Group Size without Chaperones 110 Chaperones /Teachers /Adults 10
Calculate 1 to 5 Chaperones 22
Walking Total Guests 120
TRANSPORTATION IJ Bus
Van /Car
Museum
PROGRAMS I X IMAX Title PE Time :'AFTERNOON
Workshop Title Time
Public Program Title Time
L. r No Lunch
Lunchroom Time
LUNCH Canal Cafe Time
Boxed Lunches
Tea Room Time
Ticket Price Subtotal Ticket Price Subtotal
Museum Student $1.00 Museum Group Adult $5.50
Museum Student Free Musuum Group Senior $5.00
Museum Chaperone Museum Group Child $3.50
Museum Extra Chaperone $5.50 Combo Group Adult $11.50
Museum Teacher Combo Group Senior $10.50
Combo Student $6.00 Combo Group Child $8.00
Combo Student Free $5.00 IMAX Group Adult $8.00
Combo Teacher $5.00 IMAX Group Senior $6.50
Combo Chaperone $5.00 IMAX Group Child $5.00
Combo Extra Chaperone $11.50 [MAX SE Group Adult 10 $12.50 $125.00
IMAX Student $5.00 IMAX SE Group Senior $10.00
IMAX Teacher $5.00 IMAX SE Group Child 110 $6.00 $660.00
IMAX Chaperone $5.00 SE Group Combo Adult $16.50
IMAX Extra Chaperone $5.00 SE Group Combo Senior $15.00
IMAX Special Eng Student $6.00 SE Group Combo Child $9.50
IMAX Special Eng Teacher $6.00 COMP MUSEUM
IMAX Special Eng Chaperone $6.00
Workshop Tour $2.00
Date Agent
Completed 11 -19 -08 EK
Grand Total Due $785.00 Audited U -f g C
Faxed
Order Number 105269 C onfirmed
Notes 1[L- l�. 1 o� �l�'➢f�.(.�� Gt^ ca,e-t v t
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