173460 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: T361885 Page 1 of 1
ONE CIVIC SQUARE MELISSA MONTGOMERY CHECK AMOUNT: $240.00
CARMEL, INDIANA 46032 434 3RD AVE Nw #8
o� CARMEL IN 46032 CHECK NUMBER: 173460
CHECK DATE: 6/10/2009
DE PARTM ENT ACC OUNT PO NUM INVOICE NUMBER AMOUNT D ESCRIPTION
1207 4355300 240.00 ORGANIZATION MEMBER
\.�:j OF Cilgtj
expenses
CITY OF CARMEL Expense Report (required for all travel
EXHIBIT A
EMPLOYEE NAME: pi ti. U S S✓\ Mo)-j i Go fi R I DEPARTURE DATE: TIME: AM/PM
DEPARTMENT: 1 ZO 7 RETURN DATE: TIME: AM/PM
REASON FOR TRAVEL: DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
Transportation Gas /Tolls/ Meals
Date Lodging Misc. Total
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
S
Tjtal
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 10/17/2006 Page 1
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))
Total
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 NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I 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
20
ignature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund