HomeMy WebLinkAbout240573 01/06/15 CITY OF CARMEL, INDIANA VENDOR: 00350980
® 3j ONE CIVIC SQUARE VERIZON WIRELESS CHECK AMOUNT: $**...6,411.68*
CARMEL, INDIANA 46032 P.0.BOX 25505 CHECK NUMBER: 240573
vy`TON � LEHIGH VALLEY PA 18002-5505 CHECK DATE: 01/06/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 9736047609 1,386.05 742039164-00001
1201 4344100 9736521931 80.70 280888621-00001
1205 4344100 9736521931 207.33 280888621-00001
1207 4344100 9736888991 98.67 885691434-00001
1110 4344100 9737325157 3,131.56 980914159-00001
1120 4344100 9737325183 1,140.93 980946612-00001
911 4344000. 9737534518 366.44 980755496-00001
Manage Your Account Account Number Date Due
P.O.BOX 4002 980914159-00001 01/11/15
ACWORTH,GA 30101
Invoice Number 9737325157 .
Quick Bill Summary Nov 17-Dec 16
0000359 SP 6816 46032-258403 -C33-P00359-11
Previous Balance(see back for details) $3,124.75
CITY OF CARMEL Payment—Thank You —$3,124.75
CARMEL POLICE DEPT
3 CIVIC Sq Balance Forward $.00
ACCTS PAYABLE T ANDERSON
CARMEL,IN 46032-2584 Monthly Charges $3,128.96
Usage and Purchase Charges
Messaging $.52
Data $.00
Verizon Wireless'Surcharges
and Other Charges&Credits $2.08
Taxes,Governmental Surcharges&Fees $.00
Total Current Charges $3,131.56
Total Charges Due by January 11, 2015 $3,131.56
Pay from Wireless Pay on the Web Questions:
.:) At vzw.com/mybusinessaccount 1.800,922.0204 or your
verILnwireiess Invoice Number Account Number Date Due Page
-77
9737325157 980914159 00001 07/11115 .2of 111
Get Minutes Used Get Data Used Get Balance
D, i #5AL
Explanation of Charges Payments
Verizon Wireless'Surcharges Previous Balance $3,124.75
Verizon Wireless' Surcharges include (i) a Regulatory Charge
(which helps defray various government charges we pay including Payment Thank You
government number administration and license fees); (ii) a Payment Received 12/05/14 —3,124.75
Federal Universal Service Charge (and, if applicable, a State
Universal Service Charge)to recover charges imposed on us by Total Payments 43,124.75
the government to support universal service; and (iii) an Balance Forward $.0�
Administrative Charge, which helps defray certain expenses we
incur, including:charges we, or our agents, pay local telephone
companies for delivering calls from our customers to their
customers; fees and assessments on our network facilities and
services, property taxes, and the costs we incur responding to
regulatory obligations. Please note that these are Verizon —
Wireless charges,not taxes.These charges,and what's included,
are subject to change from time to time.
Taxes,Governmental Surcharges and Fees
Includes sales, excise and other taxes and governmental
surcharges and fees that we are required by law to bill
customers.These taxes, surcharges and fees may change from
time to time without notice.
Late Fee Information
A late payment applies for unpaid balances.The charge is the
greater of$5 or 1.5%per month,or as permitted by law.
Verizon Wireless'Other Charges and Credits
Includes charges for products and services,and credits owing.
Correspondence Address Verizon Wireless Attn: Correspondence Team PO.Box'5029 Wallingford;CT 06492
VOUCHER NO. WARRANT NO.
ALLOWED 20
Verizon Wireless
IN SUM OF$
P.O. Box 25505
Lehigh Valley, PA 18002-5505
$3,131.56
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 9737325157 43-441.00 $3,131.56
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
Wednesday, December 31, 2014
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
i
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))
01/02/15 9737325157 monthly payment $3,131.56
I
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
Manage Your Account Account Number Date Due
VerIZQnwireless P.O.BOX 4002 , 980755496-00001
ACWORTH,GA 30101
Invoice Number 9737534518
0005504 03 AB 0.663 "AUTO T3 0 6620 46032-256403 -C22-P05509-11
Quick Bill Summary Nov 21 —Dec 20
l�lllllll�����1!i��li�lill�ill�ill�ilililll�rlllill�lllllll�ilili
HAMILTON COUNTY DRUG Previous Balance(see back for details) $703.81
TASK FORCE Payments—Thank You —$703.81
3 CIVIC SQ
CARMEL,IN 46032-2584. Balance Forward $.00
Monthly Charges $350.92
Usage and Purchase Charges
Voice $.00
Messaging $.00
Data $.00
Verizon Wireless'Surcharges
and Other Charges&Credits $15.52
Taxes,Governmental Surcharges&Fees $.00
Total Current Charges $366.44
Total Charges Due by January 15, 2015 $366.44
Pay from Wireless Pay on the Web Questions:
�- nwireless Invoice Number Account Number Date Due Page
Get Minutes Used Get Data Used Get Balance
1 1A 1 0 1
Explanation of Charges Payments
Verizon Wireless'Surcharges Previous Balance $703.81
Verizon Wireless' Surcharges include (i) a Regulatory Charge
(which helps defray various government charges wepay including Payments-Thank You
government number administration and license fees); (ii) a Payment Received 11/24/14 —349.70
Federal Universal Service Charge (and, if applicable; a State
C Universal Service Charge)to recover charges imposed on us by Payment Received 12/12/14 —354.11
the government to support universal service; and (ii) an Total Payments —$703.81
Administrative Charge, which helps defray certain expenses we
incur, including:charges we, or our agents, pay local telephone Balance Forward $.00
companies for delivering calls from our customers to their
® customers; fees and assessments on our network facilities and
services; property taxes; and the costs we incur responding to
regulatory obligations.-Please note that these are Verizon
Wireless charges,not taxes.These charges;and what's included,
_ are subject to change from time to time.
Taxes,Governmental Surcharges and Fees
Includes sales, excise and other taxes and governmental
surcharges and fees that we are required by law to bill
customers.These taxes,surcharges and fees may change from
time to time without notice.
Late Fee Information
A late payment applies for unpaid balances.The charge is the
greater of$5 or 1.5%per month,or as permitted by law.
Verizon Wireless'Other Charges and Credits
Includes charges for products and services,and credits owing.
w F 77-17171" "77
Corres ondence Atii Tress Verizon Wireless A#tn Come
p spondence Team PO Box 0029,W5111491` ord CT06492
VOUCHER NO. WARRANT NO.
ALLOWED 20
Verizon Wireless
IN SUM OF $
P.O. Box 25505
Lehigh Valley„ PA 18002-5505
$366.44
ON ACCOUNT OF APPROPRIATION,FOR
Project 2015-911 Task 2015-2
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior Year I hereby certify that the attached invoice(s), or
911 I 9737534518 43-440.00 I $366.44
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
" Wednesday, December 31, 2014
O-ZL-r . 1
Major
i
Title
1
Cost distribution ledger classification if
claim paid motor vehicle highway fund
� I
Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
i
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))
12/20/14 9737534518 $366.44
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
Manage Your Account Account Number Date-Due
vfr,4o wireless P.O.BOX 4002
ACWORTH,GA 30101
Invoice Number 9736888991
0008689 02 MB 0.432 "AUTO T1 0 680946033-331420 -C22-P08697-11 Quick Bill Summary Nov 10-Dec 09
IIII�I��IIIIIIIII�IIII�IIIIIIIIIIIIIIIII�IIIIIIIIIIII"III IIIIIII
CITY OF CARMEL Previous Balance(see back for details) $98.67
ATTN:KEN MILLER Payment—Thank You —$98.67
12120 BROOKSHIRE PKWY
CARMEL,IN 46033-3314 Balance Forward $.00
Monthly Charges $93.63
Usage and Purchase Charges .
Voice $.00
Messaging $.00
Data $.00
Verizon Wireless'Surcharges
and Other Charges&Credits $5.04
Taxes,Governmental Surcharges&Fees $.00
Total Current Charges $98.67
Total Charges Due by January 04,2015 $98.67
I
Pay from Wireless Pay on the Web Questions:
.: a1.800.922.0204 from
verizon wireless Invoice Number Account Number Date Due Page
9736888991885691434 00001 01/04/1,5 2 ofu
Get Minutes Used Get Data Used Get Balance
1 1A 1 :A 1
Explanation of Charges Payments
Verizon Wireless'Surcharges Previous Balance $98.67
Verizon Wireless' Surcharges include (i) a Regulatory Charge
(which helps defray various government charges we pay including Payment—Thank You
government number administration and license fees); (ii) a Payment Received 12/02/14 —98.67
Federal Universal Service Charge (and, if applicable, a State
Universal Service Charge)to recover charges imposed on us by Total Payments —$98.67
the government to support universal service; and (iii) an Balance Forward $.00
Administrative Charge, which helps defray certain expenses we
incur, including:charges we, or our agents, pay local telephone
companies for delivering calls from our customers to their
customers; fees and assessments on our network facilities and
services; property taxes; and the costs we incur responding to
regulatory obligations, Please note that these are Verizon
Wireless charges,not taxes.These charges,and what's included,
are subject to change from time to time.
C
Taxes,Governmental Surcharges and Fees
Includes sales, excise and other taxes and governmental
surcharges and fees that we are required by law to bill
customers.These taxes, surcharges and fees may change from
time to time without notice.
Late Fee Information
A late payment applies for unpaid balances.The charge is the
greater of$5 or 1.5%per month,or as permitted by law.
Verizon Wireless'Other Charges and Credits
Includes charges for products and services,and credits owing.
7-77777-77
Correspondence Address Verizon Wireless Attn Correspondence Team PO B,ox 5029 Wallingford, CT:;06492
VOUCHER NO. WARRANT NO.
ALLOWED 20
Verizon Wireless
Accounts Receivable IN SUM OF $
P.O. Box 25505
Lehigh Valley, PA 18002-5505
$98.67
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1207 I 9736888991 I 43-441.00 I $98.67 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, J uary 05, 2015
Director, Brookshire &Wblub
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))
12/09/14 9736888991 Cell Phone $98.67
I
I
I
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
Manage Your Account Account Number Date Due
veriZonwireless P.O.BOX 4002 280888621-00001
ACWORTH,GA 30101
Invoice Number 9736521931
0004802 03 AB 0.663 "'AUTO T71 680346032-258401 C22-P04806-I1 Quick Bill Summary Nov 04—Dec 03
CITY OF CARMEL ADMINISTRATION ELI
Previous Balance-(see back for details) $287.78
1 CIVIC SQ Payment—Thank You —$287.78
CARMEL,IN 46032-2584
Balance Forward $.00
Monthly Charges $276.49
1Zz:�1 , co_?o Usage and Purchase Charges
c� Voice $.00
2osz 3� Messaging $.25
12 5 = Data '$.00
Verizon Wireless'Surcharges
and Other-Charges&Credits $11.29
Taxes,Governmental Surcharges&Fees $.00
Total Current Charges $288.03
Total Charges Due by December 29, 2014 $288.03
I-
Submitted To
JAN 0 5 2014
Clerk Treasurer
Pay from Wireless I Pay on the Web Questions:
• .: r ount 1.800.922.0204 or . oyour
verr,zonwireless Invoice Number Account Number Date Due Page
°' -` 9736521931 m..280888621-00001 �12/29/14 2 of�21
Get Minutes Used Get Data Used Get Balance
WIN+SEND DA
Explanation of Charges Payments
Verizon Wireless'Surcharges Previous Balance $287.78
Verizon Wireless' Surcharges include (i) a Regulatory Charge
(which helps defray various government charges we pay including Payment—Thank You
government number administration and license tees); (ii) a Payment Received 11/24/14 —287.78
Federal Universal Service Charge (and, it applicable, a State
Universal Service Charge)to recover charges imposed on us by Total Payments —$287.78
the government to support universal service; and (iii) an Balance Forward $.�0
Administrative Charge, which helps defray certain expenses we
incur, including:charges we, or our agents, pay local telephone
companies for delivering calls from our customers to their
customers; fees and assessments on our network facilities and
services; property taxes; and the costs we incur responding to
regulatory obligations. Please note that these are Verizon.
Wireless charges,not taxes.These charges,and what's included,
are subject to change from time to time.
Taxes,Governmental Surcharges and Fees
Includes sales, excise and other taxes and governmental
surcharges and fees that we are required by law to bill
customers.These taxes, surcharges and fees may change from
time to time without notice.
Late Fee Information
A late payment applies for unpaid balances.The charge is the
greater of$5 or 1.5%per month,or as permitted by law.
Verizon Wireless'Other Charges and Credits
Includes charges for products and services,and credits owing.
Correspondence Address Verizon Wireless Attn Correspondence Team PO Box 5029 Wallingfortl, CT 06492
"VOUCHER NO: WARRANT NO.
ALLOWED 20
Verizon 1
IN SUM OF$
PO Box 25505
Lehigh Valley, PA 18002=5505
$288.03
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior Year I hereby certify that the attached invoice(s), or
1205 9736521931 43-441.00- $207.33
Prior rear bill(s) is (are)true and correct and that the
.o 9736521931 43-441.00 $80.70
materials or services itemized thereon for
which charge is made were ordered and
received except
i
Monday, January 05, 2015
Director, Administration
Title
Cost distribution ledger classification if j
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))
12/03/14 9736521931, ADMIN $207.33
12/03/14 9736521931 HR $80.70
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
Manage Your Account Account Number Date Due
ver, irelessP.O.BOX 4002 www.vzw.com/mybusinessaccount1 00001 12/18/14
ACWORTH,GA 30101
Invoice Number 9736047609
Quick Bill Summary Oct 24—Nov 23
0000525 SP 6723 46074826750 -C33-P00525-11
Previous Balance(see back for details) $1,293.83
CARMEL WATER UTILITY Payment—Thank You -$1,293.83
KERRI LOVEALL
3450 W 131 ST ST Balance Forward $.00
CARMEL,IN 46074-8267
Monthly Charges $1,316.59
Usage and Purchase Charges
Voice $.20
Messaging $.02
Data $.00
Equipment Charges $14.99
Verizon Wireless'Surcharges
and Other Charges&Credits $54.25
Taxes,Governmental Surcharges&Fees $.00
Total Current Charges $1,386.05
Total Charges Due by December 18, 2014 $1,386.05.
Pay from Wireless Pay on the Web_ Questions:
I .:) At vzw.com/mybusinessaccount 1.:11 • 04.r*611 fromyour
verrLonwireless Invoice Number Account Number Date Due Page
----77777777771
i 9736047609, 74203916440001 12/18/14 20f,169
Get Minutes Used Get Data Used Get Balance
QA
Explanation of Charges Payments
Verizon Wireless'Surcharges Previous Balance $1,293.83
Verizon Wireless' Surcharges include (i) a Regulatory.Charge
(which helps defray various government charges we pay including Payment—.Thank You
government number administration and license fees); (ii) a Payment Received 11/17/14 —1,293.83
Federal Universal Service Charge (and, if applicable, a State
Universal Service Charge)to recover charges imposed on us by Total Payments —$1,293.83
the government to support universal service; and (ii) an Balance Forward $.�0
Administrative Charge, which helps defray certain expenses we
incur, including: charges we, or our agents, pay local telephone
companies for delivering calls from our customers to their
customers; fees and assessments on our network facilities and
services; property taxes; and the costs we incur responding to
regulatory obligations. Please note that these are Verizon
Wireless charges;not taxes.These charges,and what's included, -are subject to change from time to time.
Taxes,Governmental Surcharges and Fees
Includes sales, excise and other taxes and governmental
surcharges and fees that we are required by law to bill
customers.These taxes, surcharges and fees may change from
time to time without notice.
Late Fee Information
A late payment applies for unpaid balances.The charge is the
greater of$5 or 1.5%per month,or as permitted by law.
Verizon Wireless'Other Charges and Credits
Includes charges for products and services,and credits owing.
Correspondence;Address Verizon Wireless Attn: Correspondence Team PO Box 5029 Wallingford,CT 06492
-----------------------
s_,_r
VOUCHER # 142490 WARRANT# ALLOWED
00350980 IN SUM OF $
VERIZON WIRELESS (CELL)
PO BOX 25506
LEHIGH VALLEY, PA 18002-5506
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
I
i
9736047609 01-6200-06 $14.99
9736047609 01-6360-03 $488.53
I
9736047609 01-6360-06 $882.53
I
I
Voucher Total $1,386.05
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
00350980
VERIZON WIRELESS (CELL) Purchase Order No.
PO BOX 25506 Terms
LEHIGH VALLEY, PA 18002-5506 Due Date 12/9/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/9/2014 9736047609 $1,386.05
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
/L�/,/"1 � 11A-rltl!x�
Date Officer
Manage Your Account Account Number Date Due
veriZonwirelessP.O.BOX 4002 WWW vzw.com/mybusinessaccount 9809466-12-00001 01/11/15
ACWORTH,GA 30101
Invoice Number 9737325183
Quick Bill Summary Nov 17-Dec 16
0000188 08 M13 2.235 "'AUTO T5 0 6816 46032-754302 -C24-P00188-11
�II"IIIIIIIIIII�II'111�1I IIIIIIIIIIIIIIII'IIIIII'llll"IIIIIIIII .
Previous Balance(see back for details) $1,140.42
CARMEL FIRE DEPARTMENT Payment—Thank You —$1,140.42
2 CIVIC SQ
CARMEL,IN 46032-7543 Balance Forward $.00
Monthly Charges $1,139.62
Usage and Purchase Charges
Messaging $.54
Data $.00
Verizon Wireless'Surcharges
and Other Charges&Credits $.77
Taxes,Governmental Surcharges&Fees $.00
Total Current Charges $1,140.93
Total Charges Due by January 11, 2015 $1,140.93
Pay from Wireless Pay on the Web Questions:
.: 1 / /unt 1.800.922.0204 1 from /
verl nwirefess Invoice Number Account Number Date Due Page
m.. 9737325183 980946612-0.0001 01/11/15 2 of 43 . .:
Get Minutes Used Get Data Used Get Balance
SEND #DATA+SEND #BAL+SEND
Explanation of Charges Payments
Verizon Wireless'Surcharges Previous Balance $1,140.42
Verizon Wireless' Surcharges include (i) a Regulatory'Charge
(which helps defray various government charges we pay including Payment—Thank You
government number administration and license fees); (ii) a Payment Received 12/12/14 —1,140.42
Federal Universal Service Charge (and, if applicable, a State
Universal Service Charge)to recover charges imposed on us by Total Payments —$1,140.42
the government to support universal service; and (iii) an Balance Forward $.00
Administrative Charge, which helps defray certain expenses we
incur, including:charges we, or our agents, pay local telephone
companies for delivering calls from our customers to their
customers, fees and assessments on our network facilities and
services; property taxes, and the costs we incur responding to
regulatory obligations. Please note that these are Verizon
Wireless charges,not taxes.These charges,and what's included,
are subject to change from time to time.
C
Taxes,Governmental Surcharges and Fees
Includes sales, excise and other taxes and governmental
surcharges and fees that we are required by law to bill
customers.These taxes, surcharges and fees may change from
time to time without notice.
Late Fee Information
A late payment applies for unpaid balances.The charge is the
greater of$5 or 1.5%per month,or as permitted by law.
Verizon Wireless'Other Charges and Credits
Includes charges for products and services,and credits owing.
Cor'tespondence,Address Verizon Wireless Attn:-Correspondence;Team PO'Box 5029 Waiiirtgford,°GT.06492'
VOUCHER NO. WARRANT NO.
ALLOWED 20
Verizon Wireless =A
IN SUM OF$
P.O. Box 25505
i
Lehigh Valley, PA 18022
$1,140.93
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 9737325183 43-441.00 $1,140.93 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
I,
Fire Chief
Title
I
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))
9737325183 $1,140.93
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