206871 02/29/2012 CITY OF CARMEL, INDIANA VENDOR: 365822 Page 1 of 1
ONE CIVIC SQUARE SUSAN FINKAM
z;' CHECK AMOUNT: $325.00
CARMEL, INDIANA 46032 14529 NORWALK DRIVE
CARMEL IN 46033 CHECK NUMBER: 206871
CHECK DATE: 2/29/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1401 4343004 50.00 TRAVEL PER DIEMS
1401 4357004 275.00 EXTERNAL INSTRUCT FEE
CITY OF CARMEL Expense Report (required for all travel expenses)
EXHIBIT A
EMPLOYEE NAME,, i t` t -t �r DEPARTURE DATE. TIME:
r, v
DEPARTMENT: RETURN DATE: TIME: /2-- M
AM
REASON FOR TRAVEL C k._. DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT r'.' TRAVEL PER DIEM
Transportation GasfTolisl Meals
Date p Luggage Parkin Lodging Mist. Total
Taxi Tips Lu a e g Breakfast Lunch Dinner Snacks Per Diem
f
I
l
I
DIRECTOR'S STATEMENT: f hereby affirm that all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date: �r`
City of Carmel Form ER06 Revision tale 3159,12OD9
4 z-
Page
For advance payments, claim form must be submitted ten (10) business days in advance of travel.
0 im_wt[I_n 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 it 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 $65 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), S25 for in -state travel and $30 for out -of -slate travel
For travel that ends after 1:00 p.m. (flight arrival time, if traveling by air), $50 for in -state (ravel and $65 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. t 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), I am responsible to:
1) Submit original itemized receipts to the office of the Clerk- Treasuri,r documenting all meal expenditures; and
2) Return all unused funds to the office of the Clerk Treasurer
I fuflher understand that failure to provide the required documentation shall result in the total amount of the advance being deducted fro €n 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) being deducted from the first paycheck issued more than 30 days after the date of my return.
A l
Employee Signature: l u bate:
City of Carmel form tt ER06 Re%�sion Dale 3.7812003 Page 2
REC
TRANS INTIME OUTTIME (r`:E C;C#
a
REC
TRAN UN TIME OUTTIME FE, CO
Receipt Number: CC 2
Date:
Customer Name:
Customer ID C,- Reference:
,ITEM INVOICE DESCRIPTION QUANTITY UNIT PRICE EXTENSION
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FTNK,"J.. 2rup2 1ACT -amp 0 27
0
Payment Method: Subtotal:
X K x V, Sales Tax:
Receipt Number: !D "-'C 2
Date:
Reference
ITEM INVOICE DESCRIPTION QUANTITY UNIT PRICE EXTENSION
l 2 ";VCT Ca P 00 2 75.`x
Payment Method: Subtotal:
Y. xx xx X). Sales Tax: 0
2 00
Payment Due Dale New &i8rC4 Past Due Antount Minimum Payment Aarrioll
011121112 r *^I so REWARDS.
Account nu 0"Jokova
...a your e.cI, payable to:
Chase C 0,0 S."Ic—
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New address or --I? Pnrt ar. bads.
SU S AN Ex 1J U! I C
SUSAN K FlN"M
14525 N0FI OR
CARME IN 46III33.8b
PO BOX 540,4 PALAIINE 60094-4014
%arnoll
R EWARDS, manritio your account 0.1I C—lomip, Svivicv Aodid.-I =1
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[ACCOUNT SUMMARY ORMATION
Account Number: 4388 5400 2339 all New B31ritice
Previous paymcm I Dave
pa y'
A—IIIIA? to, Cae h Owy tna rnmimum to years $7'61<
paye"Oni
5125 3 Years S+t.uo'i
it vicK, wuold like informetiivir abotit credA dun soling wrvrtrCa, t�I
1.. .866- 797.2$85.
IMARRIOTT REWARDS POINTS EARNED
Thank ynu for using your Marriott Rewards
Bonus points from Marriott HCI(3I Purchases 90 Cnwit Cad. Find out no, to redeem your N,nls
Pools earned this stalment from p,avla"s 3.71 far hotel n9ralt. travel PI Me'thadrse
Total porria; Itarnoo VI &vdonfont 5.832 anCqwfe at
Points transferred to Nlan,,"i 3.832
PO4n1!i add LP quietly weer, you use your Marriott Rewards Credit Card from Chase! Earr 3 points for every $I spent at M8nea
and I point on purcina"s rn. riverywfrero else- Also, earr, I Efilb N;pl Coedit towards Mitriiotl Rewards Pilo Status for Qve'•
53.00ri you Spend,
JACCOUNT ACTIVITY
Dam of
Transaction Merchant NanI or Transaction Description j AI
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This Statement is a Facsimile Not an original
CGGTC' F1571 i:R C: OW. I 24 Qt0k krA iAA 22' QP,
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Prescribed by state Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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 urchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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. WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Pon or INVOICE NO. ACCT #MTLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
i 71�C ,7 bill(s) is (are) true and correct and that the
I 7 materials or services itemized thereon for
which charge is made were ordered and
received except
ti aC f c� v r� 20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund