220454 05/22/2013 CITY OF CARMEL, INDIANA VENDOR: T361402 Page 1 of 1
` ONE CIVIC SQUARE TIM WOMICK CHECK AMOUNT: $1,612.82
s ro CARMEL, INDIANA 46032 1087 CAMDEN CT
<o� ASHEBORO NC 27203 CHECK NUMBER: 220454
CHECK DATE: 5/22/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4343001 962 . 82 TRAVEL FEES & EXPENSE
1192 4350900 650 . 00 OTHER CONT SERVICES
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i Willy's Mexicana Grill 12501 N Meridian St.(317)844-9333
6000 North Terminal Pkwy
Atlanta, GA 30320 q00: 04/18/2013
Host: Cashier 1 04/18/2013 Server! ,lerri 04/18/2013
CTR-473 1/10008
11:52 AM 05:43 PM
20291 Table 17/1 3145734
Tofu Reg Bur 7.10 tii�FX
Xtra Guacamole 1 Card #XXXXXXXXXXX1002
0,90
Subtotal Magnetic
ar 154 sent: WOMIGK
Tax 8,00 Approval: $ 18.53
0.66 Amount:
+ Eat In Total
8.66 + Tip:
Amex #XXXXXXXXXXX1002 _
Autj_,`' -_ 8.66 - Total'.
SIGNA
******Guest's COPY******
17
WELCOME
T S AMBER INDIAN RESTAURANT
CIRCLE K 12510 N MERIDIAN STREET
SALES RECEIPT CARMEL IN 46032
57 444 867288 317-580-0828
C K 2 3 6 3 Marchant I,D: 000002665225
18598 N COLLEGE Term ID: 00682335 Ref B: 0008
QDATE84/19/13 2 : 87PM Sale
INVOICE# 825844 g'-
AUTH## 585621 1002
ACCOUNT NUMBER AMEX Entry Method: Swiped
XXXX ?5X}{DCXX X41882
PUMP PRODUCT $/G Amount:
86 UNL8 $3 . 3 79 Tip:
GALLONS FUEL TOTAL
3 . 393 $ 11 .46 Total: ( 0�
TOTAL SALE $ 11 .46
Save 18ceent.s/gal �4/19J13 11:53:29
instantly at. Shell 188
you earn a: 000008 Appr Code: 542363
points at.GKroger—.pay Apprvd: Online BatcW 000908
Want to pay less for Customer Cops
fuel? Visit
fue lrewards . coax/rece
i p t• .
THANK YOU
HAVE A NICE QDAY
12197 North Meridian•Carmel, IN 46032 USA
0 Phone(317)843-1100 • Fax(317)705-9875 'C_7C-7'
Offic"I sponsor
If the debit/credit card you are using for check-in
WOMICK,TIMOTHY name is attached to a bank or checking account,a hold
room number: 2 18/201 Y will be laced on the account for the full anticipated
1087 CAMDEN CT address arrival date: 4/18/2013 5:44:OOPM p p
departure date: 4/19/2013 dollar amount to be owed to the hotel,including
ASHEBORO,NC 27203 estimated incidentals,through your date of check-out
US adult/child: 1/0 and such funds will not be released for 72 business
room rate: $129.00 hours from the date of check-out or longer at the
discretion of your financial institution.
RATE PLAN LV1
HH# 434130929 SILVER
AL DL #2156491652
BONUS AL CAR
Rates subject to applicable sales, occupancy, or other taxes. Please do not leave any money or items of value
Confirmation: 87058313 unattended in your room A safety deposit box is available for you in the lobby I agree that my liability for this bill is
not waived and agree to be held personally liable in the event that the indicated person,company or association fails
to pay for any part or the full amount of these charges In the event of an emergency,I,or someone in my party,require
4/19/2013 PAGE 1 special evacuation assistance due to a physical disability Please indicate yes by checking here: ❑
signature:
date , reference. description - amount iwa
4/18/2013 797313 GUEST ROOM $129.00
4/18/2013 797313 SALES TAX $9.03
4/18/2013 797313 HOTEL TAX $6.45
WILL BE SETTLED TO AX`1002 $144.48
EFFECTIVE BALANCE OF $0.00
Hilton HHon rs(R)stays are posted within 72 hours of checkout. Tog? e'Ngq€hrc�p Lr
next stay at ore than 3,900 hotels and resorts in 91 countries,please visit onors.com.
Hampton ho Is are all over the world. Find us in Canada, Costa Rica, Ecuador, Germany, India,
Mexico, Pol no, Turkey, United Kingdom, and United States of America. Comij ig soon in Italy and
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for.reservations calll:800.hampton or visit us online at hampton.com thanks.
account no. date of charge folio/check no.
card member name authorization initial
establishment no.and location establishment agrees to transmit to card holder for payment purchases&services
taxes
tips&misc.
signature of card member
X total amount
0.00
„...,, ®ova LL� n n_ HHONORS
�ioR�n CON R/sD Hilton DOURIFTREF. IrES HOME® crated v�cauoRs
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""' HILTON WORLDWIDE
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ItIq INDIANAPOLIS INT'L AP
RES. F80636283C8 /AAAE / C
s RR 591242046 #01
TIMOTHY
g WOMICK
N INITIAL CHARGES
RENT RT$ 43,73/DAY @ 2/DAYS $ 87.46
SUBTOTAL 1 $ 87
a DISCOUNT - T 10% $ 8.75
� SUBTOTAL LESS DISCOUNT T$ 78.71
CHARGES ADDED DURING RENTAL
LDW DECLINED
LIS DECLINED
PAI, PEC DECLINED
PERS DECLINED
g SERVICE CHARGES/TAXES
CONCESSION FEE RECOVERY T$ 8.66
CUST FAC CHG T$ 8.00
! TAX 17.000% ON 95.37
= TOTAL AMT DUE $1116.21.
PAID BY AMX XXXXXXXXXXX1002
qj
N YOUR CREDIT CARD WILL EXPIRE SOON PLEASE
�s CALL 800-CAR-GOLD TO UPDATE YOUR PROFILE
I� FOR EXPLANATION OF THE ABOVE CHARGES,
a PLEASE ASK A REPRESENTATIVE OR GO TO
WWW.HERTZ.COM/CHARGEEXPLAINED
N
VEHICLE:97098/9718008 13 COROLLA ry
LICENSE:IN 168AEZ
a FUEL: FULL 8/8 OUT 8/8 IN
N MILES CHECKIN: 1137
MILES @ RENTAL: 1074
MILES DRIVEN: 63
CDP: 00111 -AAA CAROLINAS
EXCH: INDIANAPOLIS INT'L AP
Q� RENTAL: 04/18/13 16:21
RETURN: 04/19/13 18:02
RETURNED: INDIANAPOLIS INT'L AP
COMPLETED BY: 4268/ININDII
aPLAN IN: AAAE RATE CLASS: C
N PLAN OUT: AAAE
� s • • A MESSAGE FROM HERTZ s s •
Z CHECK OUT OUR GREAT RATES ON
N HERTZ.COM! ENJOY GREAT DEALS AND FAST
RESERVATIONS TO MEET ALL YOUR NEEDS...
g WORK OR PLEASURE! VISIT WWW.HERTZ.COM!
**WE LOOK FORWARD TO YOUR NEXT VISIT!**
GJ HOW WAS YOUR EXPERIENCE?
WE'D LIKE YOUR FEEDBACK.
1) Call 1-800-278-1595, or
Visit WWW.HERTZSURVEY.COM
a
2) Enter Access Code: 97017
N
i� 3) Take Brief Survey
I S QUESTION?
IN Visit WWW.HERTZ.COM or
Call 1-800-654-4173
IN THANK YOU FOR RENTING FROM
HERTZ
! N
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))
05/03/13 Arbor Day 2013 Reimbursement for Arbor Day $962.82
05/03/13 Arbor Day 2013 $650.00
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.
Timothy H. Womick ALLOWED 20
IN SUM OF $
1087 Camden Ct.
Ashboro, NC 27203
$1,612.82
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1192 Arbor Day 2013 43-430.01 $962.82 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1192 Arbor Day 2013 43-509.00 $650.00
materials or services itemized thereon for
which charge is made were ordered and
received except
Tuesd y, My 21 013
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund