239840 10/09/2014 CITY OF CARMEL, INDIANA VENDOR: 366015
d ! ONE CIVIC SQUARE WEX BANK CHECK AMOUNT: S"""'140.62'
a CARMEL, INDIANA 46032 PO Box 6293 CHECK NUMBER: 239840
CAROL STREAM IL 60797-6293 CHECK DATE: 12/09/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4231400 38985397 140.62 0496-00-138002-1
I nvoi m Statement
INVOICE NUMBER: 38985397
ACCOUNT NAME: City of Carmel Admin.
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496-00-138002-1 1550.00 30 NOV-30.2014 DEC-22-2014 140.62
DATE ACTIVITY DESCRIPTION CHARGES/DEBITS PAYMENTS/CREDITS
NOV-10-2014 PAYMENT-THANK YOU 311.33
NOV-28-2014 FUEL PURCHASES 140.62
REMINDER
REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB
WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE
RIGHT PORTION OF THE REMITTANCE STUB.
Submitted To
DEC 082014
Cierk `treasurer
PURCHASES.RETURNSAND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT.
PREVIOUS BALANCE PAYMENTS (+)PURCHASES (+)DEBITS CREDITS + LATE FE = NEW BALANCE
311.33 311.33 140.62 0.00 0.00 0.00 140.62
CALL CUSTOMER SERVICE TO PAY BY PHONE
FEDERAL TAX ID: 841425616 The Late Fee is determined by Which is an EFFECTIVE ANNUAL To the balance subject to late
applying a monthly rate of RATE of fee for this period which is
2.249 % 26.99 % 0.00
SEE REVERSE SIDE FOR IMPORTANT INFORMATION AND TERMS.
TO FN541RF PRnPFR CRFTIIT TEAR AT PFRFOPATION ANf1 INrli I inn:RCTTQM P(1RTInhI tnnT�vnt rn nl�XllrbT
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))
11/30/14 38985397 $140.62
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
IN SUM OF $
PO Box 6293
Carol Stream, IL 60197-6293
$140.62
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. . INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
1205 I 38985397 I 42-314.00 I $140.62 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
Monday, December 08, 2014
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund