HomeMy WebLinkAbout172319 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 00351688 Page 1 of 1
10J� ONE CIVIC SQUARE GARY FISHER CHECK AMOUNT: $282.38
CARMEL, INDIANA 46032 316 NORRIS DRIVE
ANDERSON IN 46013 CHECK NUMBER: 172319
CHECK DATE: 5/13/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DES CRIPTION
1120 4343002 282.38 EXTERNAL TRAINING TRA
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CITY OF CARMEL Expense Report (required for all travel expenses)
EMPLOYEE NAME: DEPARTURE DATE: TIME: AM M
DEPARTMENT: RETURN DATE TIME: AM M
REASON FOR TRAVEL: ��5 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
$0.00
$0.00
4/26/09 1 $32.50 $32.50
4/27/09 $65.00 $65.00
4/28/09 $119.88 $65.00 $184.88
$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 1 $0.00 $0.00 $0.00 $0.00 $119.88 $0.00 $0.001 $0.001 $0.001 $162.50 $0.00
DIRECTOR'S STATEMENT: I hereby affirm 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 5/6/2009 Page 1
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Co Informati
Name I GT�t- L
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Home Street Address 13 i W ,�p2 +s �R rl 'f 1Qa'3 I
Home Cit State, ZIP Code
Preferred Phone Number 5 5 30 1
Email Address
License /Ce rtification Informati (Req uired for EMS Providers)
Job Title F F t -,q r,c 0j,
A enc /Em to er e�lg t rim Ot p 4-
State License Number _�Z x!09 it U) It 5 1 1 10 0
State License or Certification I
Level (Example: EMT -P)
State of Licensu 5 ry A-,-V,4
State License Ex piration Date 4 fl I0
NREMT Certification Number DI 7 7 t5
NREMT Re-re gistration date '3 3 1 7ooq
Which Coarse 11Nill °You '86� Attending l
Course Date R a 7 S
Course Location Yw LALL^,, zoo /+k 1 4 0 a
Course Tuition
($375 in Western Region /$350 in j 35p
all other regions v
How_ WiII�,Y
Select one Check 1
o Credit Card I
Amount to be charged
Type of card o Visa
o MasterCard
o Other (please specify):
o N/A
Card Number
Expiration Date
Name on Card
Securi Card Code I
Signature
�ees Pegg a Suites a ®0aga zas Page 1 of 1 f
2615 Fairfield Road
Kalamazoo, MI 49002
269 -382 -6100
leesinn.com
Gary Fisher 0. .,�s.� n
118 99182 04/2.6/2.009 04/28/2009 0.00
Master f=olio
i�` 4F�b XIS
04/26/2.009 118 Room Taxable 54.00 0.00 54.00
04/26/2009 1.18 Room Tax 6.000% 3.24 0.00 57.24
04/26/2009 11.8 Local Tax 5.000% 2.70 0.00 59.94
04/27/2009 118 Room Taxable 54.00 0.00 113.94
04/27/2009 118 Room Tax 6.000% 3.24 0.00 117.18
04/27/2009 1.1.8 Local Tax- 5.000% 2.70 0.00 119.88
04/28/2009 118 NOW 0.00 119.88 0.00
Balance Due 0.00
Summary and Taxes
Taxable Sales 108.00
Room Tax 6.00% 6.48
Local Tax 5.00% 5.40
04/2£1/2009 06:39 AM Thank you for choosing Lees Inn and Suites
VOUCHER NO. WARRANT NO.
ALLOWED 20
Gary Fisher
IN SUM OF
$282.38
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 43- 430.02 $282.38 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
MAY 1 12009
rid• 6
a
Fire Chief
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))
$282.38
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