177867 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 360690 Page 1 of 1
ONE CIVIC SQUARE JOHN THOMAS
CARMEL, INDIANA 46032 11576 CREEKSIDE LANE CHECK AMOUNT: $384.39
CARMEL IN 46033
«o CHECK NUMBER: 177867
CHECK DATE: 9129/2009
DEPARTMENT ACCOUNT PO NUM INVOICE NUMBER AMOUNT DESCRIPTION
2200 4357004 9/16/2009 384.39 EXTERNAL INSTRUCT FEE
CITY OF CARMEL Expense Report (required for all travel expenses)
EMPLOYEE NAME: John Thomas DEPARTURE DATE: 9/16/2009 TIME: 8am AM/PM
DEPARTMENT: Engineering RETURN DATE: 18 -Sep TIME: 4 m AM/PM
REASON FOR TRAVEL: INAFSM Conference DESTINATION CITY: Angola Indiana
TRAVEL EXPENSES ARE FOR (check all that apply): ADVANCE REIMBURSEMENT X PER DIEM
Transportation Gas /Tolls/ Meals
Date Lodging Misc. Total
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
09/16-
09/18 $199.36 $199.36
9/16/09 $55.00 $55.00
9/17/09 $55.00 $55.00
9/18/09 $55.00 $55.00
9/18/09 $20.03 $20.03
$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 $0.001 $0.00 $20.03 $199.361 $0.001 $0.001 $0.00i $0.00 $165.00 $0.00 $384.39
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 9/23/2009 Page 1
For advance payments, claim form must be submitted ten (10) business days in advance of travel.
Claim will not be 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 if 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 $60 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), $25 for in -state travel and $30 for out -of -state travel
For travel that ends after 1:00 p.m. (flight arrival time, if traveling by air), $50 for in -state travel and $60 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. I 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- Treasurer documenting all meal expenditures; and
2) Return all unused funds to the office of the Clerk- Treasurer
I further understand that failure to provide the required documentation shall result in the total amount of the advance being deducted from 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.
Employee Signature: Date:
City of Carmel Form ER06 Revision Date 9/23/2009 Page 2
Potawatomi Inn Page 1 of 1 4
6 Lane 100A Lake James
Angola, IN 46703
260 833 1077/260- 833 -4087
potawatomiinn @dnr.state.in.us
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John Thomas S�
11576 Creek Side Lne 1 138 207120 09/16/2009 09/18/2009 0.00
Carmel, IN 46033
Master Folio
Date Roomy Descr�pt�on
m
%Voucher��Cti gesCred�ts Balance,
09/16/2009 138 Advance Deposit From Conf 191291 0.001 99.68 99.68
i
09/16/2009 138 Room Taxable 89.00 i 0.00 10.68
09/16/2009 138 Sales Tax 7.000% 6.23 0.00 -4.45
09/16/2009 138 Tax Rate 2 County Room Tax 5.000% 4.45 0.00. 0.00
09/17/2009: 138 Room Taxable 89.00 0.00 89.00
09/17/2009 138 Sales Tax 7.000% 6.23 0.00 95.23
09/17/2009 138 Tax Rate 2 County Room Tax 5.000% j 4.45; 0.00, 99.68
i
09/18/2009 138 Visa /Mastercard ...7799 AP: 02032A 0.00 99.68 0.00
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09/18/2009 10:59 AM
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2009 INAFSM Conference
3 Pokagon State Park, Angola, IN
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September 15 -18, 2009
INV ®ICE
Recistrant Information August 20, 2009
John Thomas
City of Carmel
One Civic Square
Carmel, Indiana 46032
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Registration 2009 INAFSM Conference: John Thomas 140.00
2009 INAFSM Membership $30.00
Late fee $25.00
TOTAL AMOUNT OF PAYMENT 0
TOTAL AMOUNT DUE 195.00
Please forward payment to:
INAFSM
Attn: Unique Dahl
115 West Washington Street, Suite 1368 South Tower
Indianapolis, IN 46204
Unique Dahl (317) 536 -6721, info@inafsm.net
"When submitting payment please enclose a copy of this invoice or a completed
registration form with payment.
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
John Thomas
Purchase Order No.
Engineering Department
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
09/16/09 n/a INAFSM Conference Angola, IN Hotel, per diem $364.36
09/18/09 Gas in Angola $20.03
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
John Thomas IN SUM OF
Engineering Dept.
$384.39
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
PO# or
DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
n a 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
2 20
Signature
G1 V E ;n�t.s-✓
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund