HomeMy WebLinkAbout240330 12/16/14 CITY OF CARMEL, INDIANA VENDOR: 00350498
ONE CIVIC SQUARE INDIANAPOLIS NEWSPAPERS, INC CHECK AMOUNT: $"`""1,382.26'
307 N.PENNSYLVANIA STREET CHECK NUMBER: 240330
9 =q. CARMEL, INDIANA 46032 PO BOX 145 CHECK DATE: 12/16/14
INDIANAPOLIS IN 46206-0145
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4355200 IS0045075 421.56 IS0045075
1110 4355200 32249 IS0380767 312.03 IS0380767
1701 4355200 IS0578982 321.03 IS0578982
1203 4355200 IS5708983 327.64 IS5708983
CURRENTLY PAID THROUGH: 12/28/2014
INDYSTARAccount number: IS0578982
130 S Meridian St.
Indianapolis, IN 46204
Amount Due: 312.03
Payment Deadline: Due Upon Receipt
AV 01 111843 234158564 A**SDOT
CLERK TREASURERS OFF
1 CIVIC SQ
CARMEL, IN 46032-2584
SUBSCRIPTION STATEMENT
N
_01/01/15-12/31/15 Service __— 312..03
Amount Due 312.03
s
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. . you get access
Billing Question Hours _Contact us:
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Sunday 7am to 12pm Phone: 1-888-357-7827
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Indianapolis Star You'll need to activate your subscription in order
130 S.Meridian St. to have full access to our content through our
Indianapolis,IN 46206 ; ',digital product portfolio:www.Indystarl.com,mobile
site,(Phone/Androld apps,tablet site and the
Manage your account :e-Newspaper. Digital setup is easy,and you only
You can manage your account online by going to www.Indystar.com/services.
have to activate your subscription once from a
Log In by clicking on the link at the top right hand corner of the web site.Here desktop PC or Mac.
you can temporarily stop delivery of the print edition while on vacation,pay for If you need help,call(888)357-7827
.._
your subscription,or report a service Issue.This is easy to do.Just follow the " " "
instructions given as you enter•the site. How do you activate your subscription?
From a desktop PC or.Mac:.
Reader
Letters to the editor: 1.Go to www.indystar.com
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first IZ Pay charge will be prorated based on the start date.The Indianapolis Star will be referenced on your credit card or bank statement for any payments made toward
your subscription.
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"A's a subscriber you will have full access to our content through"wMvindyster.cdm,tablet end mobile`sites,sinartph6he application,the e-Newspaper;and home delivery;"
- - of the print edition on the days you have selected.After the promotional period ends,the Full Access subscription will continue and be-billed monthly atthe then regular--
published monthly price,less any applicable credits,unless The Indianapolis Star is otherwise notified.For subscriptions that Include print delivery,theThanksglving Day
edition is delivered with your subscription and will be charged the regular Sunday newsstand price,which Is reflected In the November payment. Premium!print Issues are
also delivered on 1/1,5/26,7/4,9/1,11/28,12/25.Applicable taxes may not be Included in the rate.If we fall to deliver a print edition,we will credit your account at the then
regular credit attributed to providing home delivery of the print edition.If at any time you decide to cancel your subscription,you may contact customer service at
1-888-357-7827 and the full amount of any balance over$2.00 will be refunded.
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E_Ff(Elec[ronle FS_mds Transfer)Wheriyouprovidea check as paymeut,youauthorize us either to use infoimationfrom yourcheck to make a one-time electronic ftrndtransfet from youraccounfor to ptocess tha paymentas a
tlI iWn An electmnia ffird tnridrr.flindi may be withdraym from vownemiintas Penn nq fVojrberk
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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.
�n Payee
I.t/r �� 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.
ll ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
S(7�7 D or bill(s) is (are) true and correct and that
the materials or services itemized thereon
i .for which charge is made were ordered and
received except
I
19
• 20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
CURRENTLY PAID THROUGH: 01/03/2015
INDYSTARAccount number: IS0045075
130 S Meridian St.
Indianapolis, IN 46204
Amount Due: 447.56
Payment Deadline: Due Upon Receipt
AV 01 111300 23415BS62 A**5DGT
�Il�llnllllnll��'�"���IIIIInJ��lll��l�lil��llll�lll�llnl�li
CARMEL MAYOR'S OFFICE
1 CIVIC SQ
CARMEL, IN 46032-2584
SUBSCRIPTION STATEMENT
Balance Forward _ 27.52T-
02/01/15-01/31/16 Service 420.04 -
Amount Due 447.56
`Secy x' 5 -- I a1.5
Ial3lao��4
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Thank you for your subscrip#ion..:__.'_,__Customer service
How • • you get access 1
Bllling Question Hours Contact us:
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digital content?
Sunday 7am to 12pm Phone:1-888-357-7827 i
"How to set up your digital access:
Indianapolis Star You'll need to activate your subscription in order,
130 S.Meridian St. ; lo have full access to our content through our
Indianapolis,IN 46206 ; digital product portfolio:www.indystar.com,mobile
site,iPhone/Android apps,tablet site and the
Manage • • .e-Newspaper. Digital setup is easy,and�you only
have to activate your subscription once(from a
You can manage your account online by going to www.indystar.com/services. ,.;desktop PC or Mac. I
Log in by clicking on the link at the top right hand corner of the web site.Here ,If you need help,call(888)357-7827.
you can temporarily stop delivery of the print edition while on vacation, pay for !.
your subscription,or report a service Issue.This is easy to do.Just follow the How do you activate your subscnptlon8
,instructions given-as you enter the site. _.... .. _,. ..l_..
• - Services From a desktop PC or Mac:
_ Letters to the editor: 1.Go to www.indystar.com j
Take advantage of your-freedom of speech.Write a letter to the editor.For more
Information,call(888)357-7827 or visit www.Indystar.com. 2.Fill in your ZIP code and phone number and click
Classified: "Set Up."
It's so simple to sell your stuff,you can do It yourself.Write it,design it and pick t
he days at www.Indystar.com or call one of our helpful Classified representatives 3.Create your profile,including your email and
at(317)444-4444. password,which you will use to log in going forward.
Celebrations:
Make your special occasion a part of history and a cherished memento. For more Note:This one-time activation process provides you
Information,call(317)444-4444, with full access through any device.
Reprints:
Get reprints of local photos that have been published by The Indianapolis Star.
For more information call(317)444-8045.
If you chose FZ Pay,you authorize The Indianapolis Star to automatically charge the credit card or bank account you Indicate on the 10th of every month,unless the 10th
falls on a weekend or holiday,and then the deduction will be taken on the next business day.Any outstanding balances will be processed with the first FZ pay charge.Your
S- first IZ Pay charge will be prorated based on the start date.The Indianapolis Star will be referenced on your credit card or bank statement for any payments'made toward
your subscription.
As a subscribe/you will have full access to our content thiougti whw.indysti3ccom;tablet and mobile sites;emartphone"epplibatioh,the e-Newspaper,`and home delivery
- of the print edition on the days you have selected.After the promotional period ends,the Full Access subscription will continue and be billed monthly at the then regular `
published monthly price,less any applicable credits,unless The Indianapolis Star is otherwise notified.For subscriptions that Include print delivery,the Thanksgiving Day
edition Is delivered with your subscription and will be charged the regular Sunday newsstand price,which is reflected In the November payment. Premium print Issues are
also delivered on 1/1,5/28,7/4,9/1,11/28,12/25.Applicable taxes may not be Included in the rate.If we fall to deliver a print edition,we will credit your account at the then
regular credit attributed to providing home delivery of the print edition.If at any time you decide to cancel your subscription,you may contact customer service at
1.888.357.7827 and the full amount of any balance over$2.00 will be refunded.
I
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EFT(Electronic Funds Transfer)Whenyouprovideacheck as a pay mont�Y ousuthorizauaelthertouseinfortnationhom Yourchecktomakeeonod3maelectronioflurdhariaferfrom yprocess ouraccountortottiepaY -mentasa
- -
VOUCHER NO. WARRANT NO.
Indiana Newspapers, Inc. ALLOWED 20
IN SUM OF$
P. O. Box 742619
Cincinnati, OH 45274-2619
$421.56
ON ACCOUNT OF APPROPRIATION FOR ;
Mayor's Office
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1160 Statement 43-552.00 $421.56 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
received except
Mond a , December 15 2014
y
i
o �
Mayor
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
12/12/14 Statement $421.56
1 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
CURRENTLY PAID THROUGH: 12/30/2014
INDYSTAR
Account number: IS0380767
130 S Meridian St.
Indianapolis, IN 46204
Amount Due: 312.03
Payment Deadline: Due Upon Receipt
AV 01 111666 2341SB563 A**5DGT
SII"�I'�I�'I�I���I��IIIII��III�II�I�IIIIII���II�I�'11'111"'1111
CARMEL POLICE V.BAILEY
3 CIVIC SQ
CARMEL, IN 46032-2584
SUBSCRIPTION STATEMENT
N
01/0_1/15-12/31/_15_ Service
mo
Aunt Due 312.03
Mace it easy v with EZ Pay.
EZ Pay is the fast and easy way to pay for your subscription. It automatically ez
charges your credit card every monthl No bills, no checks, no stamps. pay
Call 1-888-357-7827 or visit IndyStar.com/account to sign up today.
i
I �
I
Thank you for your subscriptiCustomer service
on
i
How • • you get access
Billing Question Hours Contact us:
Monday-Friday 8am to 7pm Online:www.indystar.com to the
digital content?
Sunday 7am to 12pm Phone: 1-888-357-7827
How to set up your digital access:
Indianapolis Star , You'll need to activate your subscription jin order ;
130 S.Meridian St, to have full access to our content through our
Indianapolis,IN 46206 'digital product portfolio:www.indystar.com,mobile
site,(Phone/Android apps,tablet site and the
Manage • • i ;e-Newspaper. Digital setup is easy,and you only
You can manage your account online by going to www.indystar.com/services. have to activate your subscription once from a
Lo in b clickingon the link at the to right hand corner of the web site.Here
;desktop PC or Mac.
you can temporarily stop delivery of the print edition while on vacation a for call(888)357-7827.
Log y p g If you need help,
Y P Y P ry P ,pay y_ ._._. .p' i.. ... _ ._
your subscription,or report,a service Issue.This Is easy to do,Just follow the How do you activate your subscription?
..instructions given pay ou.enter,-the site.-
From a desktop PC or Mac:
• . • - - -
_Letters to the editor:___ 1.Go to www.indystar.com
Take advantage of your freedom of speech.Write a letter to the editor.For more j -
Information,call(888)357-7827 or visit www.indystar.com. 2.Fill In your ZIP code and phone number and click
Classified: "Set Up."
It's so simple to sell your stuff,you can do it yourself.Write it,design it and pick t
he days at www.indystar.com or call one of our helpful Classified representatives 3.Create your profile,Including your email and
at(317)444.4444. password,which you will use to log in going forward.
Celebrations:
Make your special occasion a part of history and a cherished memento. For more Note:This one-time activation process provides you
Information,call(317)444-4444. with full access through any device.
Reprints:
Get reprints of local photos that have been published by The Indianapolis Star.
For more Information call(317)444-8045,
_ If you chose FZ Pay,you authorize The Indianapolis Star to automatically charge the credit card or bank account you Indicate on the 10th of every month,unless the 10th
falls on a weekend or holiday,and then the deduction will be taken on the next business day.Any outstanding balances will be processed with the first EZ pay charge.Your
first EZ Pay charge will be prorated based on the start date.The Indianapolis Star will be referenced on your credit card or bank statement for any payments made toward
your subscription.
I
`As'a subsotlber"ou'will fi'ave fu to our content tfirou h wwwirid staccom;tablet and mobile sites;smart hone'a Ilcation,"the a-News a per,'-and deli4et
Y g Y P PP P P Y' -
-— of the print edition on the days you have selected.After the promotional period ends,the Full Access subscriptlon will continue and be billed-monthly at the then regular -
publlshed monthly price,less any applicable credits,unless The Indianapolis Star is otherwise notified.For subscriptions that Include print delivery,the Thanksgiving Day
edition Is delivered with your subscription and will be charged the regular Sunday newsstand price,which Is reflected In the November payment. Premium print Issues are
also delivered on 1/1,5/26,7/4,9/1,11/28,12/25.Applicable taxes may not be included In the rate.If we fall to deliver a print edition,we will credit your accodnt at the then
regular credit attributed to providing home delivery of the print edition.If at any time you decide to cancel your subscription,you may contact customer service at
1.888.357.7827 and the full amount of any balance over$2,00 will be refunded.
I
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leFundaTranfWhnyoupovidecheckasaymentyouauthorizeuselthetouseinformatlonfronyourchecktomakeaone-time electronicfmdtrensferfromyouraccountortopossthapaymant a.EFEleronra
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INDIANA RETAIL TAX EXEMPT PAGE
City- ®f Carmel CERTIFICATE NO.003120155 002 0llii PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 1 L101
35-60000972 --y' -
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
1211212014
Indiana Newspaper, Inc. Cable! Police Department
VENDOR
SHIPS Civic Squab
P.O. Box 742619 TO Carmel, IN 46432-
Cincinnati, OH 6274-2619 (317)571-2569
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY I UNIT OF MEASURE DESCRIPTION I UNIT PRICE EXTENSION
9 Each Indianapolis Star $312.03 $312.03
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Send Invoice To:
Cannel Police Department
Attn: Pat Young
3 Civic Square
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
�e F�
pada PAYMENT
Carmel Pollee D 430 Dept. 2. • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THgTTHERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIA JT Ott$/0 FICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 1/_'keE ate Af onllee%
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
�j e� ((�� CLERK-TREASURER
DOCUMENT CONTROL NO. J L 2 4 9 A.P.V. COPY-SIGN AND {RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
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
received except
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20 1
Signature !
-- - -------- ------ Title
Cost distribution ledger classification if -
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana Newspapers, Inc. �0
IN SUM OF$
P.O. Box 742619
Cincinnati, OH 45274-2619
$312.03
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
I hereby certify that the attached invoice(s), or
32248 43-552.00 $312.03
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
Friday, December 12, 2014
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
■
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))
12/12/14 Newspaper $312.03
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
CURRENTLY PAID THROUGH: 01/10/2015
INDYSTARAccount number: IS5708983
130 S Meridian St.
Indianapolis, IN 46204
Amount Due: 353.64
Payment Deadline: Due Upon Receipt
AV 01 112368 234158566 A**5DGT
I'IIIIIIII'Ill�llnll�l�llnilillnlllu�ul'I����'ll��llllil�l�i
COMMUNITY RELATIONS DEPT CITY OF CARMEL
1 CIVIC SQ
CARMEL, IN 46032-2584
SUBSCRIPTION STATEMENT m
27.9_0
Credits/Debits 10.29 C—R---
02/01/15-01/31/16
R02/01/15-01/31/16 Service 336.03 _
Amount Due 353.64
- �a�3�laol5
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�� �eidrot. � 5�r
aa131��
Make it easy with EZ Pay.
EZ Pay is the fast and easy way to pay for your subscription. It automatically —
charges your credit card every monthl No bills, no checks, no stamps. pay-,
Call 1-888-357-7827 or visit IndyStar.com/account to sign up today.
Thank you for your subscription Customer service !,
How • • you get access
Billing Question Hours Contact us:
Monday-Friday Sam to 7pm Online:www.indystar.com to the
digital content?
Sunday lam to 12pm Phone: 1-888-357-7827
-How to set up your digital access:
Indianapolis Star ! :You'll need to activate your subscription,in order
130 S.Meridian St. to have full access to our content through our
Indianapolis,IN 46206 'digital product portfolio:www.indm
ystar.co ,mobile
(site,(Phone/Android apps,tablet site and the
Manage • account (e-Newspaper. Digital setup is easy,and you only
have to activate your subscription once from a
You can manage your account online by going to www.indystar.com/services. _ :desktop PC or Mac. I
Log in by clicking on the link at the top right hand corner of the web site.Here
you can temporarily stop delivery of the print edition while on vacation,pay for If you need help,call(888)357-7827.
your subscription,or report a service Issue.This Is easy to do.Just follow the How do you activate your subscription?
instructions given as you enter the.site.- - -.- -- --
From a desktop PC or Mac,.,,..,,-
Reader
ac:
-- - - r • - -
Letters to the editor: 1.Go to www.indystar.com
Take advantage of your freedom of speech.Write a letter to,the editor.For more
information,call(888)357-7827 or visit www.indystar.com. 2. Fill In your ZIP code and phone number and click
Classified: "Set Up." i
It's so simple to sell your stuff,you can do It yourself.Write It,design it and pick t
he days at www.indystar.com or call one of our helpful Classified representatives 3.Create your profile,including your small and
at(317)444-4444, password,which you will use to log in going forward.
Celebrations:
Make your special occasion a part of history and a cherished memento. For more Note:This one-time activation process provides you
Information,call(317)444-4444. with full access through any device.
Reprints:
Get reprints of local photos that have been published by The Indianapolis Star.
For more information call(317)444-8045.
If you chose Fs Pay,you authorize The Indianapolis Star to automatically charge the credit card or bank account you indicate on the 10th of every month,unless the 10th
falls on a weekend or holiday,and then the deduction will be taken on the next business day.Any outstanding balances will be processed with the first F2 pay,charge.Your
• first Q Pay charge will be prorated based on the start date.The Indianapolis Star will be referenced on your credit card or bank statement for any payments made toward
your subscription.
-As a'subsoriber you will hese full access to our content th'rougfi www.indystar:cotrt,tablet and mobile sites;stnartphone appllcaUon,the e•Newspaper;"arid"home delivery
- of the print edition on the days you have selected.After the promotional period ends,the Full Access subscription will continue and be billed-monthly at the then regular-
published monthly price,less any applicable credits,unless The Indianapolis Star is otherwise notified.For subscriptions that Include print delivery,the Thanksgiving Day
edition is delivered with your subscription and will be charged the regular Sunday newsstand price,which is reflected In the November payment. Premium print Issues are
also delivered on 1/1,5/28,7/4,9/1,11/28,12125.Applicable taxes may not be Included in the rate.If we fall to deliver a print edition,we will credit your account at the then
regular credit attributed to providing home delivery of the print edition.If at any time you decide to cancel your subscription,you may contact customer setvfce at
1-888.357.7827 and the full amount of any balance over$2.00 will be refunded.
i
I
i
EFT(ElechronicFundsTrnnster)Whenyouprovidea,cheek,aspaymentyouauthorizeuseither touse infomtationfromyotuohecktomxkesone-time electronicflutdtrmN rfromyouraccountor_toprocesathapaymentaea _
f ' !
VOUCHER NO. WARRANT NO.
{ ALLOWED 20
Indiana Newspapers, Inc. YTT IN SUM OF$
P. O. Box 742619 }
1
Cincinnati, OH 45274-2619
I'
$327.64
APPROPRIATION FOR
APPR
ON ACCOUNT OF O
I
Community Relations
IS S'70312)
PO#/Dept. INVOICE NO. ACCT#lrITLE AMOUNT !
Board Members
1203 Invoice 43-552.00 $327.64
I hereby certify that the attached invoice(s), or
I I I
4 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 15,2014
Director,Com nity Relations/Economic Development
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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, num er 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))
12/03/14 Invoice $327.64
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