242830 03/03/15 CITY OF CARMEL, INDIANA VENDOR: 00353077
.;; ONE CIVIC SQUARE DENNIS ROSS CHECK AMOUNT: $****'***48.00*
?q CARMEL, INDIANA 46032 C/O CARMEL WASTEWATER CHECK NUMBER: 242830
CARMEL IN 46032 CHECK DATE: 03/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 48.00 OTHER EXPENSES
Bureau of Motor Vehicles
Customer Transaction Receipt
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*.A
B V State Form 51717 (4-04)
Branch: NOBLESVILLE STARS(405) Date: 2/21/15 Time: 11:08:29 am EDT
405 NOBLE CREEK DR
NOBLESVILLE, IN 46060-3108
Visit ID: 199237477
Visit Customer: DENNIS M RUSS SR
Transactions
Trans ID (PIN) Trans Type Trans Subtype Amount
245368324 Driver- Renew CDL License Renew $48.00
Subtotal: $48.00
Sales/Use Tax:. $0.00
Credit Applied: $0.00
Total $48.00
Payment Method CREDIT Amount $ 48.00
Merchant ID advc80952we Card Type Authorization Number 100827
Terminal ID 6Z9YCP1 Entry Method S Trans Sequence No 30079528
Batch No 0 Account Number
Total Due: $48.00
Amount Paid: $48.00
Change Due: $0.00
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VOUCHER # 155002 WARRANT # ALLOWED
T9968 ? IN SUM OF $
RUSS, DENNIS
CARMEL WASTEWATER
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT j' Audit Trail Code
RUSS,DENN 01-7042-05 $48.00
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Voucher Total $48.00
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
T9968
RUSS, DENNIS Purchase Order No.
CARMEL WASTEWATER Terms
Due Date 2/25/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/25/2015 RUSS, DENS $48.00
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