229314 2/25/2014 i
CITY OF CARMEL, INDIANA VENDOR: 00351435 Page 1 of 1
ONE CIVIC SQUARE SPRINT CHECK AMOUNT: $230.03
° o CARMEL, INDIANA 46032 PO BOX 4181
CAROL STREAM IL 60197-4181 CHECK NUMBER: 229314
CHECK DATE: 2/25/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1401 4344100 148239816074 133 . 99 148239816-074
1701 4344100 148239816074 96 . 04 148239816-074
YOUR SPRINT INVOICE
> ACCOUNT INFORMATION > CUSTOMER CARE
Account Name Invoice Date Register and Logon
CITY OF CARMEL COUNCIL February 10, 2014 www.sprint.com
Account Number TIN Number Call Sprint
148239816 47-08824631-877-639-8351
Invoice Number ABA Number >Total Amount Due:
148239816-074 111-000-012 's5sg'7 > SPRINT NEWS
Upgrade Program
AND NOTICES
> MONTHLY INVOICE SUMMARY This section contains
important updates about your
January 07 - February 06,2014 Sprint Services, including
Previous Balance . 291 .71 Service or Rate Changes,
Payments as of 02/07/14 -Thank you -291 .71 Promotions and Offers.
Outstanding Balance $0.00
V0001-Access and Related Items 354.12 Correspondence
oll Please send all correspondence
0006-Equipment and Retail Purchases 199.99
including billing inquiries to:
® 0007-Sprint Surcharges 5.45 Sprint Customer Service
0008-Government Fees and Taxes 0.15 PO Box 8077
Total Current Charges for 148239816-074 Due 03/02/14 $559.711London, KY 40742
Do not enclose your payment
Total Amuht-Due--
with the correspondence.
You may also contact Sprint
�j Customer Care at the number
n listed on your invoice or by
��U going to sprint.com.
c�30
'Any unpaid balance after the due date may be subject to a late payment charge
per your contract.
o1557 3 2/8 ............................1.
Account Number Page
16
YOUR SPRINT INVOICE Account
4of16
Account Name
CITY OF CARMEL COUNCIL
> SPRINT NEWS AND NOTICES CONTINUED
International, US Territories&
possessions Rates
Int'I long distance, roaming,data and text rates
and plans, and inclusion in discounted pricing
offers are subject to change from time to time
without notice. Visit sprint.com/international to
check for included destinations and the most up to
date voice, text and data rate information.
Phone Security
Sprint encourages you to set a phone passcode or
lock to help prevent unauthorized access. See
your phone's user guide for instructions. Also
consider downloading a security app for your
phone. Report stolen phones to Sprint to protect
your account. For more information visit
sprint.com/stolenphone.
Software Updates Available
Keep your phone's software current by checking
for updates regularly. Log on to sprint.com any
time to check your alerts or go to sprint.comtlearn
and follow.the instructions for your phone. That's
getting it done right now.
Hearing Aid Compatibility
Sprintoffers a variety:of handsets that have been
rated for compatibility with several types of
hearing aids. Please visit sprint.com/accessibility
for more information.
:13ILL.I.NG FOOTNOTES'. -_
Tima PeViod �Pp-Peak P®nod OR-Off Peak Period MP•Multiple".P$rlod
Features GW Gall WaitEng CF-Call Forwarding : 3W-Three Way GaEI_ DS Dial p Service MM-Mobile to Mobile .
SN-Sprinf:Ta Home SO-Sprint TaOfflce- AC-AudioConferencing - LD-Long Dlsfance OS-Operator Services''-
wl-Wireless Integration DA-Daeotory Asi istance WC Any Mobile,Ariytlme
Networks NN-National Natworlt` OGoutofNorrisAraa IR-.IR `WD-Worldwlde:Discount TJ-Tituerra Network
OA Out.ot Area R Roaming SR Sprinl:A±rave
_Servlces" Al;-Altemats One AulAnytime/Plan Usaga PF-Partial.Free FC.Free Ca31 I WP-Wireless Priority
VW-vowiFi RN-International VoWiFi
Account Number Billing Period Page
i O U R SPRINT INVOICG
148239816 01/07/14-02/06/14 5of16
Account Name Invoice Date Invoice Number Sprint't
CITY OF CARMEL COUNCIL February 10,2014 148239816-074
> ACCOUNT SUMMARY
',ail c
Monthly Direct Connect Messaging Data and
Recurring Service Cellular LD and Other Directory Svcs. Number of Third Party Equipment and Government
Access Discount/ Minutes/ Minutes/ Assistance Minutes/ Messages/ Services KB/ Retail Sprint Fees and
Chaiges Adjustments Charges Charges Charges Charges Charges Charges Purchases Surcharges Taxes. Totals
Account Charges and Adjustments
148239816 CITY OF CARMEL COUNCIL
Subscriber Charges and Adjustments
Number/ Plan Page
Name
317-656-7989 Everything Data Share 1500 -27.50
ERIC SIDENSTICKER 6 128.00 2.77 0.03 103.30
317-201-1010 Everything Data Share 1500 517:00 722 '10,882.00 /^
DIANA CORDRAY 7 29.99 0.67 0.03 vj 30.69 ,
317-513-0242 Everything Data Share 1500 19,199.00 �•-.-f
LUCISNYDER 9 29.99 0.67 0.03 30.69
317.600-0595 Everything Data Share 1500 62:00 1:00 65 491,989.00
CINDY SHEEKS 10 29.99 0;67 0.03 d, 30.69
317.714-2721 Everything Data Share 1500 \� / 1105:00 1335 739,678.00
CINDY SHEEKS 11 29.66 9(00 0.67 0.03 129,36
317.506.0009 AIRAVE Access Point Retention
CITY OF CARMEL COUNCIL 16 0.00
3`17-551-000`1 3G/4G MBB Hotspot Plan 3GB 1,485,977.00,
CITY OF CARMEL COUNCIL 16 34.99 199.99 K� 234.98
Usage for All Subscribers 1684:00 1:00 2122 2,747,725.00
Discounts for All Subscribers -$27.50
Charges for All Subscribers $282.62 $99.00 $199.99 $5.45 $0.15 $559.71
...
ToratCurrent,Usage 1684:00 1:Ob.. 2122 2,747;725.00-
TotatCgrrentCherges $282.62 $71.50-: $199:99 $5.45 $0.15
_.
- - -
- _. ...-
Total Subscribers on Account 7
If you prefer to receive a Summary Invoice, please visit sprint.com, log into My Sprint, and select the "Change how detailed your bill is" option or
contact Customer Care. The Summary Invoice is designed for your convenience, and will not display full billing details.
0155133/8 ...................::c-.....::
.::•:•:�'a:.::.i
,1 A'y
Account Number Billing Period Page
YOUR SPRINT' INVOICE 148239816 01(07/14-02/06(14 6of16
Account Name Invoice Date Invoice Number
CITY OF CARMEL COUNCIL February 10,2014 148239816-074 Sprint'
ACCCUNT`CHARGES.ANQ ADJUSTMENTS Pian Discount Report
*MULTIPLE-When more than one discount plan is attached to the rate plan.
Note This summary report represents current number of subscribers with monthly plans and associated discounts active at the time
> ACCOUNT ACTIVITY SUMMARY of Youbilling
x
Your Extended Discounted Amount was subtracted from your Monthly Recurring Charges.
Date Received Amount Subscriber Equipment Billing Allocation
Sprint Order DM14-0-030039012,Jan 28
PREVIOUS INVOICE ACTIVITY Shipping Address:'
Previous Balance $291 .71 1 CIVIC,CARMEL,IN 46032
Bill To Billing Gov't Fees and
Payments Toward Previous Balance Reference Description Quantity Amount Taxes Total
Payment Check#227932 01/19/14 -230.36 317-551-0001 CITY OF CARMEL COON IPHONE 5S GRAY 32GB SG 1 299.99 0.00 299.99
Payment 01/14/14 -30.66
Payment 01/14/14 -30.69 Total Subscriber Equipment Charges $299.99
Subscriber Equipment Charges appear as charges under Subscriber Equipment Charges&Services section.
Total Payments -$291 .71
Outstanding 8_11- $0 00
> ACCOUNT MANAGEMENT REPORTS SUBSCRIBER CHARGES AND ADJUSTMENTS
317-656-7989.;:
::ERIC.S)DENSTIGKEt :_>.:>:;._:::.....
The following reports are compiled as a courtesy to help you analyze usage trends and manage your account activity.
Usage Summary > SUBSCRIBER ACTIVITY SUMMARY
Shared Services Usage
Billed Usage Rate/Date Amount
Usage Additional
ID Usage Type Included Used Billed Charges k.111 Monthly Recurring Access Charges
LTD1007 Anytime Minutes 1,500 445 0 Everything Data Share 1500 for 02/07-03/06 110.00
Total Additional Charges 90.00 Premium Data$10 add-on charge for 02/07-03/06 10.00
You can view Price Plan information and all breakout of minutes by subscriber in the Subscriber Informational Reports section under TEP($4 Ins.premium+ESRP) for 02/07-03/06 8.00
each phone number.
Dates presented next to a Usage a Category indicates that every subscriber on the shared plan moved to a different plan. Total Monthly Recurring Access Charges $128.00
Single Services Usagefiltl Service Discounts
Additional Business Discount Sprint 25% -27.50
Usage Type Used Billed Charges
Any Mobile,Anytime 1,116 0 Total Service Discounts $27.50
Text 1,215 0 Sprint Surcharges
Night&Weekend 123 0
Picture Mai1907 0 *Federal-Univ Sery Assess Non-LD 4.350% 1 .93
Sprint 3G/4G Data 1,485,977 0 *State-Univ Sery Assessment O,390% 0.17
Sprint.3G Data" 937,550 0
Sprint 3G Data Roaming 7,049 0 *State-Gross Receipts Recovery 1 .400% 0.67
Sprint 4G Data 317,149 0 Total Sprint Surcharges $2.77
Total Additional Charges $0.00
`Sprint Surcharges are rates we choose to collect from you to help defray costs imposed on us.Surcharges are not taxes or
Single Services Usage grid includes any service that does not have an included allowance. amounts we are required to collect from you by law. Surcharges may include:Federal USF,regulatory charges,
Single Services Usage grid includes usage from all non-shared/pooled plans and services including any non shared services that are administrative charges,gross receipts charges,and other charges incurred to recover costs associated with governmental
associated to a shared,sharing group,or pooling plan. programs.The amounts,and the components used to calculate Surcharge amounts,are subject to change.
Plan Discount Report Continued...
Discounted Extended
*Discount Associated Plan Discounted
Subscribers Plan Amount Code Discount Amount Amount
1 Everything Data Share 1500 110.00 CNVP25 27.50 82,50 82.50
Total Plan Discount $82.50
I
I
VO lJ R SPRINT INV®ICE Account Number Billing Period Page \`
148239816 01/07/14-02/06/14 7of16 1
Account Name Invoice Date Invoice Number Sprint SAW
CITY OF CARMEL COUNCIL February 10,2014 148239816-074 i @ A
317-656-7989, ERIC SIDENSTICKER cont. 317-2 DIANA`CORDRAY >:
> SUBSCRIBER ACTIVITY SUMMARY > SUBSCRIBER ACTIVITY SUMMARY
Billed Usage Rate/Date Amount Billed Usage Rate/Date Amount
Government Fees and Taxes Noll Monthly Recurring Access Charges
State -Hearing Impaired Charge 0.03 Everything Data Share 1500 for 02/07-03/06 19.99
Total Government Fees and Taxes $0.03 Premium Data$10 add-on charge for 02/07-03/06 10.00
Total Monthly Recurring Access Charges $29.999.99
Total Charged for,
103.30. ,
--- - ® Sprint Surcharges
*Federal-Univ Sery Assess Non-LD 4.350% 0.47
> SUBSCRIBER INFORMATIONAL REPORTS *State-Univ Sery Assessment 0.390% 0.04
*State-Gross Receipts Recovery 1 .400% 0.16
The following reports are compiled as a courtesy to help you analyze usage trends and manage your subscriber activity. Total Sprint Surcharges $0.67
*Sprint Surcharges are rates we choose to collect from you to help defray costs imposed on us.Surcharges are not taxes or
Your Rate Plans amounts we are required to collect from you by law. Surcharges may include:Federal USF,regulatory charges,
administrative charges,gross receipts charges,and other charges incurred to recover costs associated with governmental
Plan Services programs.The amounts,and the components used to calculate Surcharge amounts,are subject to change.
Premium Data$10 add-on charge America-Roaming Included Government Fees and Taxes
SMS Text Messages
State Hearing Impaired Charge 0.03
Long Distance While Roaming
Mobile TV Total Government Fees and Taxes $0.03
Sprint 4G Data Services
Sprint 3G Data Services Total.Charges for DIANA CORDRAY $30:64
Dom Roaming Packet Data Kbs
Video Mail
VoiceMail Included Enhanced VoiceMail > SUBSCRIBER ACTIVITY DETAIL
Required Features with Plan
Everything Data Share 1500 Call Detail To view coverage maps and rates visit Sprint.com.
Caller ID
Domestic LD Rate$0 , Cellular Services Call Detail
Anytime Minutes Footnote Long Dist.( Total
9 p 9 No. Date Time Call To Number (See pg.2) Min:Sec Usage Other Charges
Unlimited Ni his&Weekends-7 m Modified Ni hts and Weekends
Cellular Minutes 1 01107 08:05A Incoming 317-860.6230 PP/AU 1:00 0.00 0.00 0.00
Unlimited Any Mobile,Anytime Any Mobile Anytime 2 01/07 10:28A CARMEL,IN 317-571-2414 PP/AU 1:00 0.00 0.00 0100
Subscriber Usage Summary 3 01/07 10:52A Incoming 317-571-2428 PP/AU 3:00 0.00 0.00 0.00
4 01/07 10:58A Incoming 317-414-9015 PP/WC/AU 6:00 0.00 0.00 0.00
Shared Services Plan-Everything Data 5 01/07 12:28P Incoming 317-514-6538 PP/WC/AU 2:00 0.00 0.00 0.00
6 01/07 01:58P CARMEL,IN 317-571-2427 PP/AU 4:00 0.00 0.00 0.00
Usage Additional 7 01/07 02:16P Incoming 317-571-2413 PP/AU 11:00 0.00 0.00 0.00
ID, Usage Type Included Used Billed Charges 8 01/07 02:33P Incoming 317-571-2430 PP/AU 4:00 0.00 0.00 0,00
LTD1007 Anytime Minutes Shared 0 0 9 01/07 04:16P INDIANAPLS,IN. 317-507-6427 PP/WC/AU 1:00 0.00 0,00 0.00
Any Mobile,Anytime Unlimited 0 1001/07 04:29P Incoming 317-514-6538'PP/WC/AU 5:00 0,00 0.00 0.00
Text Unlimited 0 11 01/07 04:48P Incoming 317-514-6538 PP/WC/AU 4:00 0.00 0.00 0.00
Night&Weekend Unlimited 0 12 01/07 05:25P INDIANAPLS,IN 317-507-6427 PP/WC/AU 1:00 0.00 0.00 0.00
Picture Mail Unlimited 0 13.01/07 06:15P Incoming 317-514-6538 PP/WC/AU 12:00 0,00 0.00 0.00
Sprint 3G Data Unlimited 0 14 01/08 08:31A Incoming 317-514-6538 PP/WC/AU 1:00 0.00 0.00 0.00
Sprint 3G Data Roaming See Terms 0 15 01/08 09:29A INDIANAPLS,IN 317-507-6427 PP/WC/AU 1:00 0.00 0.00 0.00
Total Additional Charges $0.00 16 01/08 09:52A Incoming 317-507-6427 PP/WC/AU 3:00 0.00 0.00 0.00
To view total charges and usage,please go to the Account Level Usage Summary.To view your phone additional charges,please 17 01/08 12:29P Incoming 317-507-6427 PP/WC/AU 1:00 0.00 0.00 0.00
go to the Subscriber Activity Summary for this phone. 18 01/08 03:19P Incoming 317-514-6538 PP/WC/AU 2:00 0.00 0.00 0.00
Dates next to a Usage Type indicates a price plan change.
Continued...
0155134/8 •r!:•rl'!!''a.:P:'r......I
Account Number Billing Period Page
YOUR SPRINT INVOICE 148239816 0voice[4-02/06/14 In of 16 }
Account Name Invoice Date Invoice Number Swint i n` 4
CITY OF CARMEL COUNCIL February 10,2014 148239816-074
317.513-0242, LUCI SNYDER cont. 317.600Q595.;'CINDY SHEEKS
> SUBSCRIBER INFORMATIONAL REPORTS > SUBSCRIBER ACTIVITY SUMMARY
The following reports are compiled as a courtesy to help you analyze usage trends and manage your subscrber activty. Billed Usage Rate/Date Amount
$iail Monthly Recurring Access Charges
Your Rate Plans Everything Data Share 1500 for 02/07-03/06 19.99
Plan Services Premium Data$10 add-on charge for 02/07-03/06 10.00
Premium Data$10 add-on charge America-Roaming Included
SMS Text Messages Total Monthly Recurring Access Charges $29.99
Long Distance While Roaming Sprint Surcharges
Mobile TV
Sprint 4G Data Services 'Federal-Univ Sery Assess Non-LD 4.350% 0.47
Sprint 3G Data Services `State-Univ Sery Assessment 0.390% 0.04
Dom Roaming Packet Data Kbs `State.-Gross Receipts Recovery 1 .400% 0.16
......................... -------------------- ---Video Mail..------......... ----- .......................-..... Total Sprint Surcharges $0.67
VoiceMail Included Enhanced VoiceMail 'Sprint Surcharges are rates we choose to collect from you to help defray costs imposed on us.Surcharges are not taxes or
Required Features with Plan amounts we are required to collect from you by law. Surcharges may include Federal USF,regulatory charges,
Everything Data Share 1500 Call Detail administrative charges,gross receipts charges,and other charges incurred to recover costs associated with governmental
Caller ID programs.The amounts,and the components used to calculate Surcharge amounts,are subject to change.
Domestic LD Rate$0 Government Fees and Taxes
-------------------------------------------------AnOmeMinutes-----....--------------------------------------------- State-Hearing Impaired Charge 0.03
Unlimited Nights&Weekends-7pm Modified Nights and Weekends Total Government'Fees and Taxes $0.03
Cellular Minutes
------ ------------------------------------------------•------------- -------------.... ------------ --- --------
Unlimited Any Mobile,Anytime Any Mobile Anytime Total.Charg es for CINDY SHEEKS $30.69
Subscriber Usage Summary
Shared Services Plan-Everything Data
Usage Additional > SUBSCRIBER ACTIVITY DETAIL
ID Usage Type Included Used Billed Charges
LTD 1007 Anytime Minutes Shared 0 0 To view coverage maps and rates visit Sprint.com.
Any Mobile,Anytime Unlimited 0
Text Unlimited 0 Cellular Services Call Detail
Night&Weekend Unlimited 0 '
Picture Mail Unlimited 0 Footnote 'Long Dist./ Total
Sprint3G Data Unlimited 19,199 No. Date Time Call To Number (See pg.2) Min:Sec Usage Other Charges
Sprint 3G Data Roaming See Terms 0 1 01/07 12:28P Incoming 317-714-2714 PP/WC/AU 1:00 0,00 0.00 0.00
Sprint 4G Data Unlimited 0 2 01107 05:14P INDIANAPLS,IN 317-714-2714 PP/WC/AU 2:00 0.00 0.00 0.00
Total Additional Charges $0.00 3 01/07 05:44P Incoming 317-714-2714 PP(WC/AU 1:00 0.00 0.00 0.00
To view total charges and usage,please go to the Account Level Usage Summary.To view your phone additional charges,please 4 01/08 10:16A Incoming 317-714-2714 PP/WC/AU 2:00 0.00 0.00 0,00
go to the Subscriber Activity Summary for this phone. 5 01/08 10:42A Incoming 317-571-2428 PP/AU 1:00 0,00 0,00 0.00
Dates next to a Usage Type indicates aprice plan change. 6 01108 01:16P INDIANAPLS,IN 317-714-2721 PP/WC/AU 1:00 0.00 0.00 0.00
7 01/08 01:17P INDIANAPLS,IN 317-714-2721 PP/WC/AU 1:00 0.00 0.00 0,00
8 01/08 01:18P INDIANAPLS,IN 317-714-2714 PP/WC/AU 2:00 0,00 0.00 0100
9 01/08 01:23P INDIANAPLS,IN 317-714-2714 PP/WC/AU 1:00 0.00 0.00 0100
10 01/08 01:52P,IND IANAPLS,IN 317-714-2721 PP/WC/AU 2:00 0.00 0.00 0,00
ti 01/08 02:47P INDIANAPLS,IN 317-714-2714 PP/WC/AU 2:00 0.00 0.00 0.00
12 01/08 02:49P INDIANAPLS,IN 317-714-2721 PP/WC/AU 1:00 0.00 0.00 0100
13 01/09 10:17P NOBLESVL,IN 317-703-0987 OP/WC/AU 1:00 0.00 0.00 0.00
14 01/10 10:36A Incoming 317-714-2721 PP/WC/AU 1:00 0.00 0.00 0.00
15 01/10 09:28P Incoming 317-460-5125 OP/WC/AU 1:00 0,00 0.00 0.00
16 01/ti 02:46P Incoming 317-714-2721 OP/WC/AU 1:00 0.00 0.00 0.00
17 01/12 02:25P INDIANAPLS,IN 317-714-2721 OP/WC/AU 1:00 0.00 0.00 0.00
18 01/15 04:30P Incoming 317-714-2721 PP/WC/AU 1:00 0.00 0.00 0.00
Continued...
I I
Account Number Billing Period Page \`
YOUR SPRINT INVOICE 148239816 0voice 4-02/06/14 In of 16 y
Account Name Invoice Date Invoice Number Sprint'
CITY OF CARMEL COUNCIL February 10,2014 148239816-074 R
31 =5O6 QOQ9, CITY OF CARMEL-COUNCIL ` ;>. > SUBSCRIBER ACTIVITY DETAIL
> SUBSCRIBER INFORMATIONAL REPORTS To view coverage maps and ratesvisitSprint.com.
jk Equipment Charges&Services
The following reports are compiled as a courtesy to help you analyze usage trends and manage your subscriber activity.
Sprint Order Number Shipping Address
Your Rate Plans DM14-0-030039012,01/28/14 1 civic
CARME, IN 46032
Plan Services
AIRAVE Access Point Retention Call Detail
Actual
Caller ID Descriptlon Quantity SFIP SRP Total Charge Total
Anytime Minutes IPHONE 5S GRAY 32GB SGL 1 299,99 299.99
Enhanced VoioeMail Subtotal $299.99
Sales Tax 0.00
Total $299.99
Less Amount Paid 0.00
317.551 00D1
CITY:OF,CARMEL COUNCIL
-.- :- Total Equipment Charges&Services $299.99
> SUBSCRIBER ACTIVITY SUMMARY > SUBSCRIBER INFORMATIONAL REPORTS
&,111 Monthly Recurring Access Charges
Billed Usage Rate/Date Amount
The following reports are compiled as a courtesy so help you analyze usage trends and manage your subscriber activity.
3G/4G MBB Hotspot Plan 3GB for 02/07-03/06 34.99 Your Rate Plans
Total Monthly Recurring Access Charges $34.99 Plan Services
Equipment and Retail Purchases Cellular Call Detail Cellular Call Detail
Phone Discount 01/28/14 -100.00 3G14G MBB Hotspot Pian 3G9 $.25/MB RoamOvg-$.00024414/KB
$.05/MB OnNetOvg-$.00004882/K[3
Equipment DM 14-0-030039012 299.99 Incoming Call Restriction
Total Equipment and Retail Charges $199.99 Outgoing Call Restriction
SMS Text Messages
Total Charges-toe CITY OF CARMEL-COUNCIL: $234;98 Anytime Minutes
_.
Sprint 4G Data Services
Sprint 4G Data Services
Sprint 3G eHRPD Data
Sprint 3G Data Services
Combined 3G/4G Data Kilobytes
Dom Roaming Packet Data IQs
Subscriber Usage Summary
Single Services Plan-3G/4G MBB Hotspot Plan 3GB
Additional
Usage Type Included Used Billed Charges
Sprint 3G/4G Data 3,145,728 1,485,977 0
Sprint 3G Data Roaming 307,200 0 0
Total Additional Charges $0.00
Dates next to a Usage Type indicates a price plan change.
To view total charges and usage,please go to the Account Level Usage Summary.To view your phone additional charges,please
go to the Subscriber Activity Summary for this phone.
a _ �
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City FormNo.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.i voice(s) or bill(s))
nZIA al—
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
20Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
4191
ON ACCOUNT OF APPROPRIATION FOR
i
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I 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
1 Ei I61-t# received except
20
5..
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund