221415 07/02/2013 VOIDED AND STOP PAYMENT CITY OF CARMEL, INDIANA VENDOR: 367168 Page 1 of 1
ONE CIVIC SQUARE TONY BAVOTA
CARMEL INDIANA 46032 45 HOWARD BLVD CHECK AMOUNT: $184.80
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WATERDOWN ONTARIO CA LOR 2H4 CHECK NUMBER: 221415
CHECK DATE: 712/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4359000 184 . 80 SPECIAL PROJECTS
CITY OF CARMEL Expense Report (required for all travel expenses)
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EMPLOYEE NAME� n `\ v �-- DEPARTURE DATE: TIME: AM / PM
DEPARTMENT: 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 Parkin Lodging Misc. Total
Air-fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem
$0.00
$0.00
6/9/13 $25.08 $99.99 1 $125.07
6/10/13 $12.84 $11.45 $17.54 $41.83
6/11/13 $13.60 $13.36 $26.96
6/12/13 $13.60 $51.23 $64.83
6/13/13 $25.00 $116.66 $12.51 $11.94 $166.11
$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 $50.08 $0.00 $216.65 $0.00 $0.00 $52.55 $36.75 $68.77 $0.00 $0.00 $0.00 - s�
LESS CHECK RECEIVED $240.00
AMOUNT OWED $184.80
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 7/1/2013 Page 1
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