160960 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 186700 Page 1 of 1
0 ONE CIVIC SQUARE TODD LUCKOSKI
CARMEL, INDIANA 46032 210 CONCORD LANE CHECK AMOUNT: $9.65
CARMEL IN 46032
CHECK NUMBER: 160960
CHECK DATE: 6/25/2008
DEPARTMENT AC PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4343004 9.65 TRAVEL PER DIEMS
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CITY OF CARMEL Expense Report (required for all travel expenses)
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EMPLOYEE NAME: DEPARTURE DATE: �p D�f TIME:
DEPARTMENT: RETURN DATE: /7 e�f l TIME:
REASON FOR TRAVEL: DESTINATION CITY: I L
EXPENSES ARE FOR (check all that apply): TRAVELL DVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
Transportation Gas/Tolls/ Meals
Date Air -fare Car Rental Other Parking Lodging. Breakfast Lunch Dinner Snacks Per Diem Misc. Total
6/17108 $9.66 $9.65
$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
0.00
Total $0.00 $0.00 $0.00 $9.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
DIRECTOR'S STATEMENT: I hereby aff that all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date:
City of Carmel Form ER06 Revision Date 6/19/2008 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), 1 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) bele uct 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 6/19/2008 Page 2
VOUCHER NO. WARRANT NO.
ALLOWED 20
Todd Luckoski
I IN SUM OF
210 Concord Lane N.
Carmel, IN 46032
$9.65
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT
Board Members
1115 43- 430.04 $9.65 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
Friday, June 20, 2008
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))
06/19/08 I I I $9.65
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