226797 12/03/2013 CITY OF CARMEL, INDIANA VENDOR: 366288 Page 1 of 1
ONE CIVIC SQUARE NORMAN RILEY
CARMEL, INDIANA 46032 CHECK AMOUNT: $84.00
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CICERO IN 46034 CHECK NUMBER: 226797
CHECK DATE: 12/3/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 84 . 00 OTHER EXPENSES
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CITY OF CARMEL Expense Report (required for all travel expenses)
kD1ANP EXHIBIT A
EMPLOYEE NAME: _Norman Dale Riley DEPARTURE DATE: Ci (�`.f3 TIME: AM/ PM
DEPARTMENT: WWTP RETURN DATE: tl.l��•�t3 TIME: AM/ PM
REASON FOR TRAVEL: _A7_ CO3Jf ed"NC-(' DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM
Date Transportation Gas/Tolls/ Lodging Meals
Parkin Misc. Total
Air-fare Car Rental Other g g g Breakfast Lunch Dinner Snacks Per Diem
11/20/13 $28.00 $28.00
11/21113 $28.00 $28.00
11/22/13 $28.00 $28.00
$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 l
0.00
Total $0.00 $0.00 $0.001 $84.00 $0.00 $0.001 $0.00 $0.00 $0.001 $0.00 $0.00 o
DIRECTOR'S STATEMENT: 1 hereby affirm that all expenses listed conform to the City's travel policy and are within my department's appropriated budget:
Director Signature: Date: -
���� Revision Date 11/2612013
VOUCHER # 136898 WARRANT # ALLOWED
T9959 IN SUM OF $
RILEY, NORMAN
WASTEWATER
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
RILEY 01-7042-05 $84.00
Voucher Total $84.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T9959
RILEY, NORMAN Purchase Order No.
WASTEWATER Terms
Due Date 11/26/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/26/201; RILEY $84.00
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
Date Offipir