241214 01/22/15i
*f. CITY OF CARMEL, INDIANA VENDOR: 369037
® ONE CIVIC SQUARE AMERICAN LUNG ASSOCIATION CHECK AMOUNT: S""`""`36.00'
CARMEL, INDIANA 46032 HAMILTON COUNTY HEALTH DEPT CHECK NUMBER: 241214
18030 FOUNDATION DRIVE CHECK DATE: 01/22/15
NOBLESVILLEIN 46060
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4239099 9137022 36.00 OTHER MISCELLANOUS
r
ON
Hamilton County Health Department
Hamilton County Health Department Phone:317-776-8500
18030 Foundation Drivr Fax: 317-776-8506
Noblesville, Indiana 46060
IN VOICE 9137022
Tom Small
Carmel Fire Department
One Civic Square
Carmel, Indiana 46033
Course Name Cost Per Student Total Students Total
TB Card $6.00 6 $36.00
Subtotal $36.00
Tax 0
Balance Due $36.00
Please make check payable to:
American Lung Association
Please send payment to:
Hamilton County Health Department
18030 Foundation Drive
Noblesville, In 46060
(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))
9137022 TB Cards-Small,Alverson, Hoffman $36.00
3 CPM FF's
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
120
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
American Lung Association
Hamilton County Health Department IN SUM OF $
18030 Foundation Drive
Noblesville, IN 46060
$36.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 9137022 42-390.99 $36.00 1 hereby certify that the attached invoice(s), or
1120 42-390.99 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
SAN 2 0 2015
v
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund