240964 01/13/15 G�q.
CITY OF CARMEL, INDIANA VENDOR: 368518
® 'r ONE CIVIC SQUARE CULLIGAN WATER OF BOONE COUNTYCHECK AMOUNT: $"""`"'90.00'
CARMEL, INDIANA 46032 PO BOX 797 CHECK NUMBER: 240964
'�;,�bH�o:�• ATTN: ACCTS RECEIVABLE CHECK DATE: 01/13/15
LEBANON IN 46052
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4350100 115022 90.00 BUILDING REPAIRS & MA
I
OIF PAYING BY CREDIT CARD,PLEASE CHECK CORRECT CARD AND FILL OUT BELOW
TO
V DD �® -® ❑NLAUTOMATIC BICHECKLL BOX
ENROLL
of Boone County CARD NUMBER V.CODE
PO Box 797
Lebanon, IN 46052 SIGNATURE EXP.DATE
(765)482-2570 (317)873-8772 DATE PAY THIS AMOUNTACCOUNT NUMBER
hitp://www.culligancentralindiana.com 12/31/2014 $90.00T 115022
AMOUNT
PAY BY DATE: JAN 25 PAID $
ADDRESSEE: —REMIT PAYMENT TO:
g CARMEL CITY STREET DEPARTMENT CULLIGAN OF BOONE COUNTY ,,,,,
ATTN: JAMES BENTLEY PO BOX 797
a 3400 W 131ST ST LEBANON, IN 46052-0797
CARMEL IN 46032
BALANCE FORWARD BRANCH ID:CW-LE
RETURN THIS TOP PORTION WITH YOUR PAYMENT CUSTOMER:CARMEL CITY STREET DEPARTMENT
.......... ..................._..................................
.,.,...__ --
PREVIOUS BALANCE: I $0.00
DATE QUANTITY DESCRIPTION REF AMOUNT I BALANCE
12/30/2014 1.00 CULLIGAN SERVICE CALL 90.00 90.00
U
ACCOUNTS ARE SUBJECT TO A LATE PAYMENT FINANCE CHARGE
FINANCE CHARGE SCHEDULE PL EASE P4Y NEW
OVER PERIODIC RATE WWALRATE BALANCE BEFORE
S .5 1.7=' =-.°° ' j-.i'' 2
5WN
Balance Due I $90 . 00
TO J l 117(1()% 1:,1111 '(CHARGE 1j 1-1 I
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Next Deliveries:
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( 765J� (317) ".73-;77-
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7=:[EL T EY STATEMENT DATE ACCOUNT NUMBER NAME
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115022
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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))
12/31/14 $90.00
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
Culligan of Boone County
IN SUM OF $
P.O. Box 797
Lebanon, IN 46052-0797
$90.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
2201 43-501.00 $90.00 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
ry 015
Street Commissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund