172520 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 362874 Page 1 of 1
ONE CIVIC SQUARE CHRIS ROHR
CARMEL, INDIANA 46032 CHECK AMOUNT: $162.50
CHECK NUMBER: 172520
CHECK DATE: 5/13/2009
D:PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT D
1120 4343002 162.50 EXTERNAL TRAINING TRA
CITY OF CARMEL Expense Report (required for all travel expenses)
/ND I AN F
EMPLOYEE NAME: 1 1 1�1 �o�-�c DEPARTURE DATE: TIME: AM M
DEPARTMENT: RETURN DATE ';Z> 1 ZN1 TIME: AM M
REASON FOR TRAVE DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
Date Transportation Gas/Tolls/ Lodging Meals Misc. Total
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
$0.00
$0.00
4/26/09 $32.50 $32.50
4/27/09 $65.00 $65.00
4/28/09 $65.00 $65.00
$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 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $162.50 $0:00
c
DIRECTOR'S STATEMENT: I re aff that all ex ensz� listedi nform to the City's travel policy and are within my department's appropriated budget.
MAY 1 12009
Director Signature: Date:
City of Carmel Form ER06 Revision Date 5/6/2009 Page 1
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Reg F
Contact :l' mation
Name
Home Street Address
Home City State, ZIP Code
Preferred Phone Number_ 3r 7 9 3 6'x-- 7
Email Address (rp ca,tic;r
L- icens6ICertifica tion In'formati'on Req uired f ENIS'Provid0s)
Job Title
A enc /Em Ipso rer IffAArU--
State L icense Number L S O5
State License or Certification
Level Exam le: EMT -P
State of Licensure
Sta License Expiration Date _i_p_/ /p_���
NREMT- Certifi Numbe IA
NREMT Re- reg istration dat e_
Wh "c' Cours Will:You`Be.Atten'din'
Course Date
Course Location
Course Tuition
($375 in Western Region /$350 in
all other reg
Ho w Wfll Yo Be
Pa in
_Y g__
Select one Check
Cr Card
Amount to be chim
Type of card o Visa
MasterCard
Other (please specify):
1 o N/A
Card Number
Ex oration Date
Name on Card
Securi Card Code
Signature
t-- i
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))
$162.50
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
VOI.ICH_ ER N.P. WARRAN NO.
ALLOWED 20
Chris Rohr
IN SUM OF
$162.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 43- 430.02 $162.50 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 112009
e
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund