241226 01/22/15 y u,Coq*
a^ CITY OF CARMEL, INDIANA VENDOR: 359016
b ONE CIVIC SQUARE KAREN BREEDLOVE CHECK AMOUNT: $**.....125.00*
r CARMEL, INDIANA 46032 520 SUPER STAR CT CHECK NUMBER: 241226
�M'�roN�°' CARMEL IN 46032 CHECK DATE: 01/22/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 11615 125.00 OTHER EXPENSES
Cleaning Invoice
Week Date Fee Place
01. tq.2015 125.00 Water Dist. Office
Please Remit to:
Michelle Breedlove
Backflow Prevention -Cross-Connection Control
Carmel Water Dist. Office
3450 W 131 S` Street
Carmel, IN 46074
(317) 733-2845
Total Due: 125.00
Mich lle Breedlove
7255 Testimony Ave
3D
Carmel, In 46033
317-281-1463
1
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
T5962
BREEDLOVE, MICHELLE Purchase Order No.
CARMEL WATER DISTRIBUTION Terms
Due Date 1/13/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/13/2015 11615 $125.00
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
Date Officer
VOUCHER # 142732 WARRANT # ALLOWED
IN SUM OF $
T5962
BREEDLOVE, MICHELLE
CARMEL WATER DISTRIBUTION
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
11615 01-6360-06 $125.00
i.
Voucher Total $125.00
Cost distribution ledger classification if
claim paid under vehicle highway fund