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					            S 11\I            D' eN WORNIA l'EI,SONNFL ADMINISTRATION

            TRAVEL EXPENSE CLAIM                                                                                         See Instructions and 'Privacy
            S r: )0/ (RE:V 71?OO5)                                                                                        Statement on Reverse Side                                            Page              1          of               1             Pages
    C-"

        C.J\IMANT'S NAME
                                                                                                           SSN or EMPLOYEE NUMBER"                                    DEPARTMENT


            LAURA N CHICK                                                                                                                                                                      Planning & Research
        ,10 illlON                                                                                                                  DIVISiON or BUREAU                                                               INDEX NUMBER


            Inspector General                                                                              1::D
                                                                                                                 e: pt              Governor's Office                                                                                       226
        Rf:(;IDENCL ADDRESS'                                                                                                        HEADQUARTERS ADDRESS                                                             TELEPHONE NUMBER


                                                                                                                                    1400 Tenth Street                                                                 (916) 397-9477
    ICilY                                                                                    STATE         liP                      crrv                                                      STATE                                 liP
                                                                                              ,
                                                                                              J'                                    Sacramento                                                CA                                    95814
                                                         131                                       (4)     (5)           MEALS                           16)       (7)
                                                                                                                                                                                             TRANSPORTATION                                 181               I'j
                                                                     LOCATION                                                                                              (A)         (OJ        Ie)                (OJ


    h"""'W'"      " Scpt 2009
             (:I) DATl                      TIME
                                                                  WHERE EXPENSEs
                                                                  WERE INCURRED
                                                                                              LODGING      OREAK· FASl     LUNCH
                                                                                                                                    oT  ,lJ1. N/C.
                                                                                                                                      RElG OR
                                                                                                                                       DINNER
                                                                                                                                                      INCIDEN
                                                                                                                                                        TALS
                                                                                                                                                                     COST
                                                                                                                                                                         TI~ANS
                                                                                                                                                                                 or   TYPE
                                                                                                                                                                                      USED
                                                                                                                                                                                               CARFARE
                                                                                                                                                                                                TOLLS
                                                                                                                                                                                               PARKING
                                                                                                                                                                                                              PRIVATE CAR

                                                                                                                                                                                                            MIl_ES
                                                                                                                                                                                                                            usr
                                                                                                                                                                                                                       AMOUNT
                                                                                                                                                                                                                                      BUSINESS
                                                                                                                                                                                                                                      EXPENSE
                                                                                                                                                                                                                                                            TOTI\I
                                                                                                                                                                                                                                                      EXPENSES' OR
                                                                                                                                                                                                                                                             OAY




                    l) )                   15iO          lrcsno                                    9,j08                                    18.00                                                                                                            II J08

                   9"2                    15:00          Fresno                                                   6.00      10.00                                                                                                                              16.1)(1



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    -




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-



:,0
                                                        SUBTOTALS
                                                                                                  9408           6.00      10,(1)          18.00                                                                                                           12K.IIK
-.

COLUMN CODE (ACCTG, USE ONLY)


                                                        CLAIM TOTAL                                                                                                                                                                                  12808
                  P:..JH;)~)S:            Or   Tr~IP,   RI:MAHKS AND DEl AILS (Attach receipts/vouchers when reqcnrod)
                                                                                                                                                                                                          ,'L)   NV"M~L    VVV", "V,,,,,




    Press conFerence with                                      us Attorney, Fresno and Tulare                    District Attorneys and Fresno Mayor. Meeting
                                                                                                                                                                                                         (13) PRIVATE' VEHICU      ucr    NSf" NUMfll-h'
ldiiorial board of Fresno Bee.
-
:'Jost receipt for breakfast on 9/2/09.
                                                                                                                                                                                                         (14) MILEAGF RAH~ CI AIMED

---
                                                                                                                                                                                                                                  0,55
--
                                                                                                                                                                                                         AGENCY ACCOUNTING OFFICE
                              ) I! I~[ llY CI-R l IfY I hat n18 above IS a true statement of tho lravel expenses mcurred by me In acccrdaoco with DP/\ Jules m n1C service of the Slate of                       USE ONLY
        ,    I~   t: '-nit:    Il   il   privately cwnnd veructo was used, and I! mileage rates exceed lhn minimum raw. I certuv that the cost of operating the vctuc!c was equarto or                        PAID [3y REVOLVING FUND CHECK NUMBErl

cr .atur lnan Inc rate claimed and that I have mel/he requirements as prescribed by SAM Sections 07tJO. 0751, OitJ?                                0753 and 0754
.                                   ~
                                                                     /?gJiA-i/) ~

                                                                                                        Room No.                838
     Laura Chick
     1400 10th St
                                                                                      Arrival                 09-01-09
     Sacramento, CA 95814                                                                               Departure               09-02-09

     United States                                                                                      Page No,
               1 of 1

                                                                                                       Folio No.               525999

     INFORMATION INVOICE                                                                               Cont. No.               521533

     Membership No.                                                                                    Cashier No.             107

     AIR Number
                                                                                       User 10                 WMARTIN
     Group CClde

     Company Name                                                                                                              09-02-09                           ~



Date             Text                                                                                                            Charges                Credits

09-01-09         Room                                                                                                                 84.00
09-01-09        City Tax 12%                                                                                                          10.08

                                                                                    Total                                             94.08                   0.00

                                                                                    Balance                                                       94.08




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                                                              Thank You For Staying With Us




 agree that my liability for this bill is not waived and agree to be held personally responsible in the event that the indicated person, company or association
ails to pay for any portion or the full amount of these charges.


3uest Signature                                                  _

                                                         Radisson Hotel & Conference Ctr. Fresno

                                                                   2233 Ventura Street

                                                                    Fresno, CA 93721

                                                      Telephone: (559) 268-1000 Fax: (559) 441-2954

     HERO'S SPORTS
   LOUNGE & PIZZA CO.

        3443 Laguna Blvd

           Elk Grove
                                     APPLEBEE~S
                     916-632-8200
                     NEIGHBORHOOD GRILL &BAR
                                                           2501 Fulkerth Rd
           9/1/2009            8:53:00 PM                 Turlock, CA 95380
Card Type:             Master Card
Card Number:           XXXXXXXXXXXX2269      ADRIANA T               TB#63-C3

De I've I' Nan'le:     STEPHANI              DATE: 09-02-09 TIME: 02:05 PM GUESTS: 2

Check Number:          39510                 -----------------------------------------
Tab 1e Number':        25                   CARD TYPE: t~ASTERCARD

                                            CARD NUMBER: *********2269

                                            APPROVAL CODE: 27286Z

TOTAL AMOUNT DUE                 25.17      Merchant 10:

                                            Trans Type: Auth

    TIP
                                            Amount:                        13.53

                                            Tip:
                                                          -'------~------------



                                            Total         ------_._-~----------




                                            Cardmember agrees to pay total in
                                            accordance with agreement governing
                                            use of such card.

                                                        ** GUEST COpy **

				
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