239730 12/03/2014 (9,
CITY OF CARMEL, INDIANA VENDOR: 368792
ONE CIVIC SQUARE STEPHANIE GRIGGS CHECK AMOUNT: $"'"""""11.22'
CARMEL, INDIANA 46032 C/o LAW CHECK NUMBER: 239730
CHECK DATE: 12/03/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4355300 11.22 ORGANIZATION & MEMBER
Indiana Payment Portal Page 1 of 1
Your transaction is complete
J
Your transaction is'complete. Print this receipt for your records. Your receipt identification number
i is 14816721. Please reference this number in any correspondence regarding your transaction.
Payer Information ?
,STEPHANIE GRIGGS
:1737 SNEAD DR
XOKOMO, IN 46902
Phone
'Email stephaniegriggs@att.net
------------- -------
Account Information ?
Transaction Details
Unit Extended
Description Quantity
Price Price
!Notary Application Fee $10.00 1 $10.00
'Instant Access Fee $1.22 1 $1.221 I
;Total $11.221
.............. ......... -------- .............
The following amounts have been charged to your credit card. Your credit card statement will show
the followinq merchant names)and.amounts)for this transaction.
Merchant Amount
I IIN Sec of State 800-236-5446 $11.22i
The total amount charged to your credit card is $11.22.
-Privacy Statement
https://secure.in.gov/apps/kwikekard/checkout/servlet/receipt?token=08632CC0643009B... 11/21/2014
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
Stephanie Griggs
Purchase Order No.
One Civic Square
Terms
Carmel, Indiana 46032
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/25/14 4355300 Reimburse Stephanie Griggs for Nota Application $11.22
-- -- fee per attached
Total
1 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
Stephanie GFiggG I' IN SUM OF $
I
One Civic Square
Carmel, Indiana 46032
$ $11.22
i
ON ACCOUNT OF APPROPRIATION FOR
Department of Law - 1180
C
435-5300 -Organization & Member Dues `
Board Members
PO#or
DEPT.# INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the.attached invoice(s),
1180 5300 $11.22 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
1�10YPrn1�P( o 2014
Signature
Cost distribution ledger classification if itle
claim paid motor vehicle highway fund