HomeMy WebLinkAbout229673 2/25/2014 CITY OF CARMEL, INDIANA VENDOR: 361528 Page 1 of 1
ONE CIVIC SQUARE STAPLES BUSINESS ADVANTAGE CHECK AMOUNT: $759.91
CARMEL, INDIANA 46032 DEPT DET
PO BOX 83689 CHECK NUMBER: 229673
CHICAGO IL 60696-3689
CHECK DATE: 2/25/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4230200 3220901311 67 . 89 OFFICE SUPPLIES
911 4230200 3221672254 53 . 10 OFFICE SUPPLIES
1081 4230200 3221672278 -67 . 89 OFFICE SUPPLIES
1081 4230200 3221672281 67 . 89 OFFICE SUPPLIES
1125 4230200 36587 3221672282 170 . 99 ICE MELT/SCANNER
1205 4230200 3222588665 308 . 23 OFFICE SUPPLIES
1701 4230200 3222588666 37 . 08 OFFICE SUPPLIES
1701 4230200 3222588667 114 . 80 OFFICE SUPPLIES
1081 4230200 3222588669 -67 . 89 OFFICE SUPPLIES
1081 4230200 3222588670 56 . 25 OFFICE SUPPLIES
1081 4230200 3222588671 19 .46 OFFICE SUPPLIES
INVOICE DATE CUSTOMER SUMMARY INVOICE.
2 O1 14 DET 1061088 8028592887
PLEAS!5:P.AY TERMS AMOUNT DUE
3/03/14 Net 30 Days 53.10
INVOICE DETAIL
Staples Advantage Federal ID #:04-3390816
CITY OF CARMEL-NJPA /ITY OF CARMEL
JIM SPELBRING ATTN: MARIE DOAN
1 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032 DELIVER BY 4PM
ME(� L, IN 46032
Bill to Account: 1030382 Ship to Account: 3 CIVIC SQUARE
Budget Ctr: 110 - POLICE DEPARTMENT Invoice Number: 3221672254
P 0 Number: Release: Order: 7112716199-000-001
Ordered by: MARIE DOAN Job: Order Date: 1/31/14
r r r r113/113 n i .,Ship Unitx
Line Item Number Description Qt Qt Meas , Qty Price Price
1 943889 BIONAIRE OFFICE HEATER 1 EA 1 32.93 32.93
2 591602 COVER 58806 REPORT CL ACETATE 1 BX 1 20. 17 20. 17
Freight: ax - o a : 53.10
Total: .53.10
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0013632-1014631-0000003
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))
01/31/14 3221672254 $53.10
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
Staples Advantage
IN SUM OF $
Dept. DET
P.O. Box 83689
Chicago, IL 60696-3689
$53.10
ON ACCOUNT OF APPROPRIATION FOR
Project 2014-911 Task 2014-2
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
911 I 3221672254 I 42-302.00 I $53.10 1 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
Tuesday, February 18, 2014
Major
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
[BY:
INVOICE;:DATE :CUSTOMER SUMMARY INVOICE
2 01 14 DET 1061088 8028592888
LEASE PAY BY TERMS AMOUNT 1)UE_
FEB 0 72014 3 03 14 Net 30 Days
IN OI CE DETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION CITY OF CARMEL
PAULA SCHLEMMER ATTN: COURTNEY SCHLAEGEL
1411 E 116TH ST 1427 E 116TH ST
CARMEL, IN 46032 CARMEL, IN 46032
Bill to Account: 1030597 Ship to Account: 1427 E 116TH ST
Budget Ctr: 1125-100-410-4230200 PARKS PLANNING Invoice Number: 3221672282
P 0 Number: 36587 Release: Order: 7112489689-000-001
Ordered by: DAWN KOEPPER Job: Order Date: 1/28/14
order, order ' Unit Ship Unit - . x e
Line Item Number Description Oty Oty Meas Qty Price Price
1 822663 ICE MELT BLEND GRN SCAPES 50LB 50 50 EA 8.91 .00
This item is not available at this time.
Please contact Customer Service for I u r t h e r assistance.
2 758320 NEAT SCANNER 1 EA 1 170.99 170.99
Freight-
.00 ax Sub-Total:
Total: 170.99
Item number 822663 is currently not available
Please contact your customer service team for further
assistance
s �iuE7&
11254-13- 4230200.
Customer Service inquiries.# 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0001260-1049642-0000005
INVOICE DATE CUSTOMER SUMMARY INVOICE
T72-57-14 DET 1061088 8028506308
PLEASETPAY BY
2 24714 Net 30 Days 362.17
INVOICEDETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION � FOREST DALE ELEMENTARY SCHOOL
a...��{ ��.p ATTN: VALESK SIMMONDS
PAULA SCHLEMMER ,,,�
1411 E 116TH ST 107221 LAKESHORE DR W
CARMEL, IN 46032 FEB 0 3 2014 VALESKA SIMMONDS
CARMEL, IN 46033
BY:
Bill to Account: 1030597 Ship to Account.: FORESTDALE ELEM
Budget Ctr: 1081-4-4230200 FOREST DALE ELEMENTARY Invoice Number: 3220901311
P 0 Number: XX-147 Release: Order: 7112148085-000-001
Ordered by: DAWN KOEPPER Job: Order Date: 1/21/14
r r UrderUnit Ship Unit Exte
Line Item Number Description Qt Qt Meas Qty Price Price
1 891406 HP CE320A BLACK TONER 1 EA 1 67.89 67.89
Freight: axj .00001/6) .00 Sub-Tota
Total: 67.89
5u�pu�s
XX- IL-7 F
q-LpZ30200
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0016033-1044630-0000003
RyltrT'—D INVOICE DATE CUSTOMER SUMMARY. INVOICE
275-7114 DET 1061088 8028592888
FEB 0 7 2014 ASE
3/03/14 Net 30 Days 170.99
BY:
INV ICE DETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION FOREST DALE ELEMENTARY SCHOOL
PAULA SCHLEMMER ATTN: VALESK SIMMONDS
1411 E 116TH ST 107221 LAKESHORE DR W
CARMEL, IN 46032 VALESKA SIMMONDS
CARMEL, IN 46033
Bill to Account: 1030597 Ship to Account: FORESTDALE ELEM
Budget Ctr: 1081-4-4230200 FOREST DALE ELEMENTARY Invoice Number: 3221672281
P 0 Number: XX-147 Release: Order: 7112148085-002-001
Ordered by: DAWN KOEPPER Job: Order Date: 1/29/14
FZ-rB—er orderUnit Ship Unit ERTEF05a-1
Line Item Number Description Qt 'Oty Meas Qty Price Price
2 891406 HP CE320A BLACK TONER 1 EA 1 67.89 67.89
Freight: . ax' -00 Sub-Total :
Total: 67.89
1081-� �30�0
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0001259-1049642-0000004
PLEASE:PAY BY' TERMS
'-*� a INVOICE:DATE CUSTOMER SUMMARY INVOICE
2/01/14 DET 1061088 8028592888
FEB 0 7 2014
3/03/14 Net 30 Days 170.99
BY:
INVOICEDETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION FOREST DALE ELEMENTARY SCHOOL
PAULA SCHLEMMER ATTN: VALESK SIMMONDS
1411 E 116TH ST 107221 LAKESHORE DR W
CARMEL, IN 46032 VALESKA SIMMONDS
CARMEL, IN 46033
Bill to Account: 1030597 Ship to Account: FORESTDALE ELEM
Budget Ctr: 1081-4-4230200 FOREST DALE ELEMENTARY Invoice Number: 3221672278
P 0 Number: XX-147 Release: Order: 7112148085-001-001
Ordered by: DAWN KOEPPER Job: Order Date: 1/24/14
r rr r m ip, Unit Extended
Line XIt.
Number 'Description Qty Oty Meas Qty Price Price
1 891406 HP CE320A BLACK TONER 1 EA 1 67.89 67.89-
reig axSub-Total: -
Total: 67.89-
*****Credit for Invoice# 3220901311*****
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0001258-1049642-0000003
TNT � INVOICE DATE CUSTOMER SUMMARY INVOICE
' FEB 1 4 2014
2/08/14 DET 1061088 8028697497
LEASE PAY BY TFRMS:�
AMOUNr'.DUE
3/10/14 Net 30 Days 7.82
BY:
INVOICE DETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION FOREST DALE ELEMENTARY SCHOOL
PAULA SCHLEMMER ATTN: VALESK SIMMONDS
1411 E 116TH ST 107221 LAKESHORE DR W
CARMEL, IN 46032 VALESKA SIMMONDS
CARMEL, IN 46033
Bill to Account: 1030597 Ship to Account: FORESTDALE ELEM
Budget Ctr: 1081-4-4230200 FOREST DALE ELEMENTARY Invoice Number: 3222588669
P 0 Number: XX-147 Release: Order: 7112148085-003-001
Ordered by: DAWN KOEPPER Job: Order Date: 2/04/14
Order, Order mShip UnitExtended
Line Item Number Description 'Qtv Qt Meas" Qt Price,. Price
1 891406 HP CE320A BLACK TONER 1 EA 1 67.89 67.89-
Freight: , ax: Sub-Total:,- -
Total: 67.89-
*****Credit for Invoice# 3220901311*****
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0003123-1045492-0000003
P
PIFICM1 13
lNV0ICE:::DATE..: :;:CILISTCIMEW::.. MARY:,:INVOICE.
sum
2/08/14 DET 1061088 8028697497
FEB 14 2014 P Lr=ASr:�P.AY:BY�f:,:TERM AMOUNT::.
3/10/14 Net 30 Days FBY:
INV OICEDETAIL
Staples Advantage Federal 10 #:04-3390816
CARMEL CLAY PARKS AND RECREATION TOWNE MEADOW ELEMENTARY SCHOOL
PAULA SCHLEMMER ATTN: SHANDI BRAY
1411 E 116TH ST 10850 TOWNE RD
CARMEL, IN 46032 DENEYSE SOLAZZO
CARMEL, IN 46032
Bill to Account: 1030597 Ship to Account: TOWNE MEADOW
Budget Ctr: 1081-9-4230200 TOWNE MEADOW ELEMENTARY Invoice Number: 3222588670
P 0 Number: XX-189 Release: Order: 7113009611-000-001
Ordered by: DAWN KOEPPER Job: Order Date: 2/06/14
r - I -� I . .1 . ' _ . . 1 1. 1 ; I I . order B/0 Unit Ship Unit- Extenclecl
Line Item Number Description . Qt y Qt y Meas Qty. ,Orice,, Price
1 463621 SHARPENER POWERHOUSE ELECTRIC I EA 1 24.97 24.97
2 126465 STPLS FLLR REINFORCED WR 10OCT 3 PK 3 2.00 6.00
3 810351 3TAB HEAVY WEIGHT FF ASST 50PK 2 2 BX 9.73 .00
4 711382 STAPLES YELLOW #2 PENCIL 48 4 BX 4 3.78 15. 12
5 377253 CLIPBOARD MEMO 8 EA 8 1 . 27 10. 16
Freight: lax:( _0000 Sub-'rota I 56-25
Total: 56.25
Balance to follow
IC
( og � -�-�a3�aoc�
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page:
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
L
0003124-1045492-0000004
R FFr,
INVOICE DATE ..CUSTOMER SUMMARY:*.:INVOICE::;
2/08/14 DET 10610'88 8028697497
PLEASE�.IPAY'.�13.y� TERMS:.
FEB 14 2014 3/10/14 Net 30 Days 782
B nv.
Y:
INVOICE DETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION TOWNE MEADOW ELEMENTARY SCHOOL
PAULA SCHLEMMER ATTN: SHANDI BRAY
1411 E 116TH ST 10850 TOWNE RD
CARMEL, IN 46032 DENEYSE SOLAZZO
CARMEL, IN 46032
Bill to Account: 1030597 Ship to Account: TOWNE MEADOW
Budget Ctr: 1081-9-4230200 TOWNE MEADOW ELEMENTARY Invoice Nunt)er: 3222588671
P 0 Number: , XX-189 Release: Order: 7113009611-000-002
Ordered by: DAWN KOEPPER Job: Order Date: 2/06/14
F 'r r Order B/O Unit, Ship Unit Ex rK
'Lit Item Nuniber, Description Qty' Qty Meas '', Qty- Price"- 'Price
3 810351 3TAB HEAVY WEIGHT FF ASST 50PK 2 BX 2 9.73 19.46
reilax:t .0000 Sub-Total: 9.46
..Total 19.46
Dot 4'_A"aDZkCD
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 11
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
L
0003125-1045492-0000005
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
361528 Staples Business Advantage Terms
Dept DET 2368
P.O. Box 83689
Chicago, IL 60696-3689
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
2/1/14 3221672282 Office scanner 36587 F $ 170.99
1/25/14 3220901311 Toner XX147 $ 67.89
2/1/14 3221672281 Toner XX147 $ 67.89
2/1/14 3221672278 Credit for item not received XX147 $ (67.89)
2/8/14 3222588669 Credit for item not received XX147 $ (67.89)
2/8/14 3222588670 Office supplies xx189 $ 56.25
2/8/14 3222588671 Office supplies xx189 $ 19.46
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 TOTAL $ 246.70
20_
Clerk-Treasurer
Voucher No. Warrant No.
361528 Staples Business Advantage Allowed 20
Dept DET 2368
P.O. Box 83689
Chicago, IL 60696-3689 In Sum of$
$ 246.70
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund / 108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
36587 F 3221672282 4230200 $ 170.99 1 hereby certify that the attached invoice(s), or
1081-4 3220901311 4230200 $ 67.89 bill(s) is (are)true and correct and that the
1081-4 3221672281 4230200 $ 67.89 materials or services itemized thereon for
1081-4 3221672278 4230200 $ (67.89) which charge is made were ordered and
1081-4 3222588669 4230200 $ (67.89) received except
1081-9 3222588670 4230200 $ 56.25
1081-9 3222588671 4230200 $ 19.46
20-Feb 2014
$ 246.70 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
110 INVOICE DATE.."' : CUSTOMER ><''': SUMMARY:INVOICE
2/08/14 DET 1061088 8028697496
125PLEASE PAY:BT-YM7�-
3/10/14 Net 30 Days 820.09
INVOICE DETAIL
Staples Advantage Federal ID #:04-3390816
CITY OF CARMEL-NJPA CITY OF CARMEL
JIM SPELBRING ATTN: JEFF BARNES
1 CIVIC SQUARE 1 CIVIC SQUARE
CARMEL, IN 46032 DELIVER BY 4PM
CARMEL, IN 46032
Bill to Account: 1030382 Ship to Account: 1 CIVIC SQUARE
Budget Ctr: 1205-DOA Invoice Number: 3222588665
P 0 Number: 2340 Release: JEFF BARNES Order: 7112793716-000-001
Ordered by: JEFF BARNES Job: Order Date: 2/03/14
r r orderUnit Ship -,,Unit Extended
Line Item Number 'Description' Qty Qty Meas . Qty Price Price
1 951504 SAMSUNG CLT-W406 WSTE TNER BOT 2 EA 2 13.89 27.78
2 943815 SAMSUNG CLT-Y406S YELLOW TONER 2 EA 2 56.09 112. 18
3 943813 SAMSUNG CLT-M406S MAGENTA TONR 1 EA 1 56.09 56.09
4 943816 SAMSUNG CLT-C406S CYAN TONER 1 EA 1 56.09 56.09
5 943814 SAMSUNG CLT-K406S BLACK TONER 1 EA 1 56.09 56.
.reig . .00 ax: Sub-,Total: . ..
_' Total:
''306.23
FFEB
itted To
2 4 2014
Clerk Treasurer
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0015469-1050912-0000003
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))
02/08/14 3222588665 $308.23
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
Staples Advantage
IN SUM OF $
Dept DET PO Box 83689
Chicago, IL 60696-3689
$308.23
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 I 3222588665- I 42-302.00 I $308.23 1 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
onday, February 24, 2014
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
INVOICE DATE CUSTOMER:::: .
SUMMARY:INVOICE
2 O8 14 DET 1061088 8028697496
PLEASE�PAY BY :�:TEAM AM
aim%iw
3/10/14 Net 30 Days 820.09
I1 Wof CEi DETAIL
Staples Advantage Federal ID #:04-3390816
CITY OF CARMEL-NJPA CITY OF CARMEL
JIM SPELBRING ATTN: ANN DAVIS
1 CIVIC SQUARE 1 CIVIC SQUARE
CARMEL, IN 46032 DELIVER BY 4PM
CARMEL, IN 46032
I
Bill to Account: 1030382 Ship to Account: 1 CIVIC SQUARE
Budget Ctr: 140 - COMMON COUNCIL Invoice Number: 3222588666
P 0 Number: Release: Order: 7112869808-000-001
Ordered by: ANN DAVIS Job: Order Date: 2/04/14
r r.. . ,orderUnit Ship Unit," x e
Line . .Item Number Description Qt ` Qt Meas' `Qt PricePrice
1 108985 SF4 SPEEDPOINT STAPLES 5000CT 5 BX 5 2. 10 10.50
2 237628 MEMO SLIPS 4X6 WHT.500SHT 3 PK 3 .57 1.71
3 385550 BIC WITE-OUT CORRECT TAPE 4 3 PK 3 8. 29 24.87
Freight: ax:. -lotal
Total: 37,-081
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0015470-1050912-0000004
INVOICE DATE CUSTOMER SUMMARY INVOICE
2/08/14 DET 1061088 8028697496
AMOUNT DUE
3/10/14 Net 30 Days 820.09
IlW®ICE DETAIL
Staples Advantage Federal ID #:04-3390816
CITY OF CARMEL-NJPA CITY OF CARMEL
JIM SPELBRING ATTN: ANN DAVIS
1 CIVIC SQUARE 1 CIVIC SQUARE
CARMEL, IN 46032 DELIVER BY 4PM
CARMEL, IN 46032
Bill to Account: 1030382 Ship to Account: 1 CIVIC SQUARE
Budget Ctr: 140 - COMMON COUNCIL Invoice Number: 3222588667
P 0 Number: Release: Order: 7112946355-000-001
Ordered by: ANN DAVIS Job: Order Date: 2/05/14
FURIEFF Order ni ip 'Unit x e
Line Item NumberDescr i tion Qt 'QtyMeas Qt Price -° Price
-
1 790113 STAPLER DESK ELECTRIC BK 1 EA 1 38.82 38.82
2 731626 HP 60XL BLACK INK * 1 EA 1 34.99 34.99
3 731654 HP 60XL COLOR INK 1 EA 1 40.99 40.99
Freight: 00 � Total-:
114.80
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0015471-1050912-0000005
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
(] Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
L� I✓T -PC
L cfit�Z'
$
ON ACCOUNT OF APPROPRIATION FOR
"1
fit
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
12 37 Cq 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
Signat
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund