179325 11/11/2009 1
CITY OF CARMEL, INDIANA VENDOR: 204048 Page 1 of 1
ONE CIVIC SQUARE ADAM C MILLER CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032
CHECK NUMBER: 179325
CHECK DATE: 11/11/2009
V E PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2l0 4357000 100.00 TRAINING SEMINARS
G\ n QBTeR H �F!
CITY OF CARMEL Expense Report (required for all travel expenses)
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EMPLOYEE NAME: Adam Miller DEPARTURE DATE: 10/20/2009 TIME: AM PM
DEPARTMENT: Police RETURN DATE: 10/21/2009 TIME: AM/PM
REASON FOR TRAVEL: SWAT Training DESTINATION CITY: Camp Atterbury Edinburgh
EXPENSES ARE FOR (check all that apply) TRAVEL ADVANCE TRAVEL REIMBURSEMEN TRAVEL PER DIEM XXXX
Transportation Gas/Tolls/ Meals
Date Lodging Misc.�Total
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
10/20/09 $50.00 _$5000
10/21/09 $50.00 $50:00
$0:00
xc
$0:'00
:.$0.00
40.00
$0:00
$000
$o�oo
;$0.00
$0.00
$0:00
$,0:00
N g 1,$ 0
000
0 00 �o:no W$o 00 $0 00 0 00 $0:00, o0 00 r
Total 00
$0 $0 00 $0.:00
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:
�``'i I� f Carmel Form 9 ER06 Revision Date 10/28/2009 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 $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 $32.50 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 $32.50 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 $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. 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 ERO6 Revision Date 10/28/2009 Page 2
Prescribed by Stale Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
on 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
Adam C. Miller Purchase Order No.
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/5/09 reimburse Sgt. Adam Miller for meals while attending 100.00
SWAT Training on October 20 22 2009 at Cam
Atterbur
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
A dam C. Miller
IN SUM OF
100.00
ON ACCOUNT OF APPROPRIATION FOR
cont ed fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
210 570 100.00 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
November 5 2 0 09
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund