177320 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 357812 Page 1 of 1
ONE CIVIC SQUARE WILLIAM MISER
CARMEL, INDIANA 46032 5208 ROLAND DRIVE CHECK AMOUNT: $79.00
INDIANAPOLIS IN 46228 CHECK NUMBER: 177320
CHECK DATE: 9/15/2009
DEP ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4343001 REIMB 89.00 TRAVEL, FEES EXPENSE
1192 4343004 REIMB 90.00 TRAVEL PER DIEMS
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CITY OF CARMEL Expense Report (required for all travel expenses)
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EMPLOYEE NAME: William Craig Miser DEPARTURE DATE: t3 TIME: 1 0 G AM AS>
DEPARTMENT: _Building and Code Services RETURN DATE: Z 0 TIME: 14 AM
REASON FOR TRAVEL: Training DESTINATION CITY: d4aea
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
8/27/09 $89.00 $89.00
81'26109 $25.00 $25.00
8127!09 $50.00 $50.00
$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
0.00
Total $0.00 $0.00 $0.00 $0.00 $89.00 $0.00 $0.00 $0.00 $0.00 $75.00 $0.00
r� 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:
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City of Carmel Form ER06 Revision Dale €3/28/2609 page 1
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TELEPHONE 574 277 -9373 FAX 5742430128 USA official sponsor U.S. Olympic Team W
MISER, CRAIG 308 /KXPL
X name room number: 8/26/2009 4:28:OOPM
address arrival date: 8/27/2009 6:33:00AM
X. PA 55555 departure date
adult/child: 1/0.00
room rate:
u ne aec :aeei; car: ;oar ar .sine for cn ec <.i s ar:acrec :c a bans or cec'nne munt, a had •,v it RATE PLAN L-GVT
be ola,— on the ccccn: ;or the `cll aIr ic;os;en oollar amour- to de owee :c the novel, !naud;r,g HH#
nma;ed rc d =_n;ai .:hrouyr your date o; n out anc such funds will not oe reieasec ;or 72 bugr.ess AL:
ucr --uon o; Your financiai'nstitution. CAR:
houa iron ;he dale o; cnx -cc; r. onge at the
CONFIRMATION NUMBER 87537938 Rates sublet; :c applicaole sales, ccculoana, or other taxes. Please do not leave any money or items of value unatcenced in
you; morn... safer; deposit boo. is available for you in :he loony. agree that my liability for this 'bill's not waived and agree
to be held cersonaliy liable ;n :ne event that the ncicated oerscn, comoany or association fails to pay for any part or the
8/27/2009 PAGE 1 full arnount of these charces. I nave :eques;ed weekcay delivery ^f US TOG !f r- fused, a credit will be applied to :ny
accu:n ;..n ;he event o; an emercene;, I, or someone in my p rty, require seeciai evacuation due to a physical d;sac;iirc
Please indicate yes by chec'<ing nor=: 1
signature:
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8/27/2009 792981 ROOM SHORT SNGL EXEMPT 9.00
8/27/2009 792982 ($89.00)
BALANCE $0.00
EXPENSE REPORT SUMMARY
09 00:00:00 STAY TOTAL
ROOM TAX $89.00 $89.00
DAILY TOTAL $89.00 $89.00
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account nn date of charge folio /cheek no.
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card member name auihonZation Initial
MISE CRA 30725B
establishrni em no. and location t ourchases services
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signature of card member
total amour's -89.00
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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))
08/26/09 1 night hotel $89.00
08/26/09 1.5 day travel per diem $90.00
1 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 N
ALLOWED 20
William Miser
IN SUM OF
c/o One Civic Square
Carmel, IN 46032
$179.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1192 43- 430.01 $89.00 1 hereby certify that the attached invoice(s), or
1192 43- 430.04 $90.00
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
Monday, September 14, 2009
Director, DOCS
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund