241862 02/03/15 t�ur..4�gys
i CITY OF CARMEL, INDIANA VENDOR: 307600
}' CHECK AMOUNT: $""""`650.00'
.i; ® d• ONE CIVIC SQUARE TREASURER OF STATE
=Q' CARMEL, INDIANA 46032 IN STATE BUDGET AGENCY CHECK NUMBER: 241862
200 W WASHINGTON ST,RM 212 CHECK DATE: 02/03/15
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351501 ISDT-1022 650.00 EQUIPMENT MAINT CONTR
Invoice
Indiana State Department of Toxicology
To: Carmel Police Department
3 Civic Square
Carmel, IN 46032
Invoice Number: ISDT-1022 Invoice Date: January 21, 2015
Item: 2015 Evidential Breath Test Instrument Maintenance Agreement
Pay this amount $650 f
You may now pay online with a debit or credit card by going to: https://www.payinsov.com/toxicology
If paying by check or money order, please make them payable to: Treasurer of State
Remit to: Indiana State Budget Agency
200 W. Washington Street, Rm 212
Indianapolis, IN 46204
Retain this portion for your records
VOUCHER NO. WARRANT NO.
Treasurer of State ' ALLOWED 20
Indiana State Budget Agency IN SUM OF$
200 W. Washington Street, Rm 212
Indianapolis, IN 46204
$650.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1110 ISDT-1022 43-515.01 $650.00 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, January 28, 2015
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))
01/26/15 ISDT-1022 2015 maintenance agreement $650.00
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
20
Clerk-Treasurer