175661 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
4,
ONE CIVIC SQUARE DIANA CORDRAY
b CHECK AMOUNT: $249.40
CARMEL, INDIANA 46032 11843 STONEY BAY CIRCLE
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CARMEL IN 46033-9501 CHECK NUMBER: 175661
CHECK DATE: 8/6/2009
DEPA RTMENT ACCOUNT PO NUMBER I NUMB AMOUNT DESCRIPTION
1701 4343004 249.40 TRAVEL PER DIEMS
z;
WERI Prepared For
07/15/09
New Activity continued Am unt
06/29/09 CAREY LIMOUSINE INDIINDIANAPOLIS 50.16 f�
3172412522
i Description
CHARTER SERVIC
06/29/09 ANN TAYLOR ATL 881 OSEATTLE 48.72
WOMEN'S CLOTHING T'
T 06/30/09 NORDSTROM 1 0001 SEATTLE 39.31
DEPARTMENT STORE
Description
NA RRATIV E
4
07101109 NORTHWEPTHWE SITU ST AIRLINES SEATTLE WA 15.00
a NORTHWEST AIRLINES
From: To: Carrier:
SEATTLE WA MINNEAPOLIS MN NW
N INDIANAPOLIS IN NW
0
Ticket Number: 01 22501 99551 70 Date of Departure: 01/01
Passenger Name: CORDRAY /D
gV4 Document Type: PASSENGER TICKET f�
07/09/09 DELTA AIR LINES ATLANTA GA 249.40
DELTA AIR LINES
From: To: Carrier. Class: /a 1 0 L)
INDIANAPOLIS IN ATLANTA GA DL LA U r
SAVANNAH GA DL LA,�
ATLANTA GA DL UB
INDIANAPOLIS IN DL LIB
Ticket Number: 00621128524995 Date of Departure: 08 /04
Passenger Name: CORDRAY /DIANA
Documen Type: PA TICKET
Continued on Page 4
Please detach here'
Travel Insurance Premium Refund/Credit Form Reasons for Refund/Credit
Please seethe back if requesting refunds forTravelAssure, TravelAssure Non -fare airline services charge(s) (e.g. excess baggage,
Classic or InternationalMedicalProtection .Otherwise, continue below. :itinerary charges, upgrade, or any other non -air transportation charge)
01,, fill ,.,,+th c term to rPnuest refunds for travel insurance premiums An uninsured person
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
k 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.
PoVee
Purchase Order No.
1 Terms
Date Due
Invoice invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
ib 1
Total
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
VOUCHER NO. a —WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. 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
20
Signature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund