213308 10/09/2012 \,f CITY OF CARMEL, INDIANA VENDOR: 360469 Page 1 of 1
0 ONE CIVIC SQUARE CONNIE MURPHY
CARMEL, INDIANA 46032 9 HENSEL CT CHECK AMOUNT: $143.19
CARMEL IN 46033 CHECK NUMBER: 213308
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4343004 143 . 19 TRAVEL PER DIEMS
FRENCH L
RESORT"
Name: CONNIE MURPHY Arrival Date: 10/03/2012 Cl Clerk RPADGETT
Address: 1 CIVIC SQUARE Departure Date: 10/04/2012 CO Clerk JSCHNEPP
CARMEL IN 46033 Group Code: 101 21A
R.o.etn ,.:.. .:. FL 2622 R�su...: ;::" 41 1410524010 Page 1 of 1
Rate: Refer @ts :: , Q`escription;
or Credits
10/03/2012 411849000340 ROOM CHARGE FL 2622 125.00
TAX1 9.03
TAX2 5.16
10/04/2012 411851232362 FL FRONT DESK 143.19
xxxxxxxxxxx
Total Due .00
I agree to remain personally liable for the payment of this account if the corporation or other third party
fails to pay part or all of these charges. I also agree that all charges contained in this account are correct f
and any disputes or requests for copies of charges must be made within five (5) days after my departure.
If you are using a credit card, the hold may last up to 3 business days past your check-out date. If you
are using a debit card, the hold on funds may last from 7-10 business days after your check-out date.
Guest Signature:
French Lick Springs Hotel 8670 West St Road 56 French Lick, IN 47432
888.936.9360 frenchlick.com
I
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
6RUAL MwOu
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
�d
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
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
[� �✓U�� �1 U"v�I
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
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund