173246 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 358573 Page 1 of 1
ONE CIVIC SQUARE WILLIAM BRUCE BUCKSOT
CHECK AMOUNT: $114.66
CARMEL, INDIANA 46032 931E 191ST
WESTFIELD IN 46074 CHECK NUMBER: 173246
CHECK DATE: 6/10/2009
DEPARTMEN ACCOUNT PO NUMBER INVO NUMBER AMO DESCRIPTION
601 5023990 114.66 EMPLOYEE PEN BENEFI
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CITY OF CARMEL Expense Report (required for all travel expenses)
\AfDIANj
EXHIBIT A
EMPLOYEE NAME: G(/�, t XU DEPARTURE DATE: TIME: (AM PM
DEPARTMENT: RETURN DATE: O TIME: I vzJ AM PM
REASON FOR TRAVEL: -r,2d DESTINATION CITY: C 7 5 A
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 9 Breakfast Lunch Dinner Snacks Per Diem
as 9 9 1 X $0.00
31a i 8. 7 $0.00
a og 23 g $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
i 14 cr0 1 ).00
Total $0.001 $0.00 $0.00 so-001 $0.001 $0.001 $0.001 $0.001 $0.001 $0.001 WHIM= i
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. 1 j q tot
Director Signature: Date: I IIISSS���ttt--- III���
City of Carmel Form ER06 Revision Date 3/18/2009 Page 1
AMENDMENT WIN CARMEL INUS Trace
#170094
05/
0
0
0 7
05/
share
0
Trace #7017
05/02/
04/30
04/30/0
04
04/27
04/24 /09 04/24/09 WITHDRAWAL 5542_EXXONMOBIL $42.00 $1,572.76
47299011 EXXO NMOBIL 4729
MONTGOMERY ALUS Trace #533155
04/23 /09 04/23/09 WITHDRAWAL 5812 $48.78 $410.43
ANTHONYS PUB CHAR LES ANTHONYS
P MONTGOMERY ALUS Trace #299531
04/21 /09 0421/09 WITHDRAWAL 5812 LONE STAR- $23.88 $459.21
MONT00162032 L ONE STAR- MONT0016
MONTGOMERY ALUS Trace #57 223
04
https: /www.fonnncuonline. com/ Account History /PFHistoryMain .aspx ?AcctSfx= 2&AcctType =C... 5/21/2009
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 i t
performed, dates of service rendered, by whom, rates per day, number of units, rV
price per unit, etc.
Payee
T9987
Bucksot, Bruce Purchase Order No.
Carmel Water Terms
Due Date 6/2/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/2/2009 42009 $114.66
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and f have audited same in accordance with IC 5- 11- 10 -1.6
Date Offi
VOUCHER 091972 WARRANT ALLOWED
T9987 IN SUM OF
Bucksot, Bruce
armel Water WX
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
42009 01- 6040 -05 $114.66
Voucher Total $114.66
Cost distribution ledger classification if
claim paid under vehicle highway fund