HomeMy WebLinkAbout244581 04/21/15 CITY OF CARMEL, INDIANA VENDOR: 361528
j ONE CIVIC SQUARE STAPLES BUSINESS ADVANTAGE CHECK AMOUNT: $•""•1,220.26•
?� CARMEL, INDIANA 46032 DEPT DET CHECK NUMBER: 244581
9�p�TON go• PO BOX 83689 CHECK DATE: 04/21115
CHICAGO IL 60696-3689
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4238900 3261311712 330.00 OTHER MAINT SUPPLIES
1082 4239039 3261311721 40.88 GENERAL PROGRAM SUPPL
1081 4239039 3261311722 101.81 GENERAL PROGRAM SUPPL
1081 4230200 3261311723 131.53 OFFICE SUPPLIES
1091 4230200 3261311724 300.12 OFFICE SUPPLIES
1091 4230200 3261311725 5.69 OFFICE SUPPLIES
1125 4230200 3261311726 163.90 OFFICE SUPPLIES
1701 4230200 3262319734 118.91 OFFICE SUPPLIES
1701 4230200 3262319738 27.42 OFFICE SUPPLIES
3/28/15 DET 1061088 803.3805106":.... .
PLfi°BEP'AY B�f�TERM6=kr ri A It�#N73 bl�E ; y
nk
4/27/15 Net 30 Days 330.00
INVOICE DETAIL
staples Advantage Federal 'ID.;# 94-339:0816
Bill to Account: 1030382 Ship to Account: 1 CIVIC SQUARE, _
CITY OF CARMEL-NJPA CITY OF CARMEL
JIM SPELBRING ATTN. JEFF BARNES
1 CIVIC SQUARE 1 CIVIC SQUARE
CARMEL, IN 46032 DELIVER BY 4PM
CARMEL, IN 46032
Budget Ctr 1205-DoA Invoice Number: 3261311712
Budget Ctr Desc: order 7134049610=000=001
P 0 Number : 2340 Ordered By JEFF BARNES
P o Desc" Order Date 3/26/15
Release
Release Desc
order order B/o unit ship: unit.. :Extended
Line Item Number Description Qty Qty Meas Qty Price.: .'Price
1 607949 CLEANER ENDUST 150Z 24 EA 24 .13.7.5'. "330..00
Freight: .00 Tax:( .0000 %) .00 sub-Total: 330.00
Total:
Submitte
APR:2 0 2015
@er�c Treasure
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Customer Service inquiries 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks a able to Sta les Advantage, De t DET PO Box 83689, Chica o IL 60696-3689
VOUCHER NO. WARRANT NO.
ALLOWED 20
Staples Advantage
IN SUM OF$
Dept DET PO Box 83689
Chicago, IL 60696-3689
$330.00
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 I 3261311712 I 42-389.00 I $330.00 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
Monday, April 20, 2015
Director,-Administration
Title
Cost distribution ledger classification if
claim paid motor 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit,etc.
Payee
i
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
03/28/15 3261311712 $330.00
I
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
GUS7o1;lR+ 'sMffRYtf�t1IQICE',
3/28/15 DET 1061088 8033805110
APR 10 2015 1
BY: 4/27/15 Net 30 Days 743.93
1W010E DETAIL
Staples Advantage Federal ID #:04`-3390816
Bill to Account: 1030597 Ship to Account. WOODBRK ELEM
CARMEL CLAY PARRS AND RECREATION WOODBROOK SCHOOL
PAULA SCHLEMMER ATTNe NIKEESHA PITTMAN
1411 E 116TH ST 4311 E 116 ST
CARMEL, IN 46032 NIKEESHA PITTMAN
CARMEL, IN 46033
Budget Ctr 1081-11-4230200 WOODBROOK ELEMENTARY Invoice Number: 3261311721 •�
Budget-ctr DeSC: - order : 7133809396-000-001
P O Number XX-1870 Ordered By DAWN KOEPPER
P 0 Desc order Date 3/23/15
Release
Release Desc
order order B/o Unit Ship Unit Extended
Line Item Number Description Qty Qty Meas Qty Price Price
1 124826 VIS-A-VIS FN BLK WET ERASE DZ 1 DZ 1 9.87 9.87
2 700564 GREAT ERASE BOLD POCKET MARKER 1 ST 1 3.54 3.54
3 125310 VIS-A-VIS OVERHD MARKER ASST 8 1 PK 1 6.76 6.76
4 849398 STPLS FLLR PPR CR 8.5X11 40OCT 2 PK 2 2.63 5.26
5 288640 PERMANENT MARKERS 24PK ASSORT 1 PK 1 15.45 15.45
Freight: .00 Tax:( .0000 %) .00 sub-Total: 40.88
Total: 40.88
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - - . - ...._.-.............................................--
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customer service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks a able to st les Advantage, Dept DET Po Box 83689, Chicago IL 60696-3689
11L ;yam {I �r: �¢ � wa t .�F>:st �$'»1, l.. i -
��Jll���' IN17,ot D' Ea,;�; UST�tJ'1Ek� :.;a 'x�SUMMARYI11OIC_E3
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APR 1.0 2015 3/28/15 DET 1061088 8033805110
71 PLE14S�P1Yk� ERM$ ,� i AMOUNT_DI�E
w
- ---=-_ 4/27/15 Net 30 Days 743.93
IAWOICE DETAIL
Staples Advantage Federal ID #:04-3390816
Bill to Account: 1030597 Ship to Account: SMOKY ROW ELEM
0
CARMEL CLAY PARRS AND RECREATION SMOKY ROW ELEMENTARY SCHOOL
PAULA SCHLEMMER ATTN: AMY BALDAUF
1411 E 116TH ST 900 W 136TH ST
CARMEL, IN 46032 AMY BALDAUF
CARMEL, IN 46032
Budget Ctr 1081-8-4230200 SMOKY ROW ELEMENTARY Invoice Number: 3261311722
Budget Ctr Desc: order 7133844964-000-001
P 0 Number xx-1875 Ordered By : DAWN KOEPPER
P 0 Desc Order Date 3/23/15
Release
Release Desc
Order order B/O unit Ship unit Extended
Line Item Number Description Qty Qty Meas Qty Price Price
1 608000 PENCIL 372-2 BLK WAR R BLACK 18 DZ 18 2.54 45.72
2 642736 SHARPIE MKR ULTRA FN BLK DZ 4 DZ 4 6.49 25.96
3 343719 SHARPIE FINE PINK RIBBON CANIS 1 PK 1 24.99 24.99
4 570318 LIQUID PAPER DRYLINE GRIP 2PK 1 PK 1 5.14 5.14
Freight: .00 Tax:( .0000 %) .00 Sub-Total: 101.81
Total: 101.81
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Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks a able to Sta leS Advantage, Det DET Po Box 83689, Chicago IL 60696-3689
3/28/15 DET 1061088 8033805110
APR 1 Q 2015
BY':-
:7E7
Net 30 Days 743:93
1A7010E DETAIL _
staples Advantage - Federal ID #:04-3390816
Bill to Account: 1030597 Ship to Account: 1235 CNTRL PK E
CARMEL CLAY PARKS AND RECREATION CITY OF CARMEL
PAULA SCHLEMMER ATTN: LINDA ACOSTA
1411 E 116TH ST 1235 CENTRAL PARK DR E
CARMEL, IN 46032 DLV BEFORE 4PM
CARMEL, IN 46032
Budget Ctr 1081-99-4230200 ESE ADMINISTRATION Invoice Number: 3261311723
Budget Ctr Desc: order :.7133996108-000-001-
P
7133996108-000-001_P 0 Number XX-1892 Ordered By DAWN KOEPPER
P 0 Desc Order Date 3/25/15
Release
Release Desc
order order B/O unit ship unit Extended
Line Item Number Description Qty Qty Meas Qty Price Price
1 486158 OFFICE PANEL ORGANIZER 8-1/2 3 PK 3 7.09 21.27
2 082613 STPLS STAN VIEW BNDR 11N BLK 3 EA 3 4.60 13.80
3 736031 HANDSET COIL CORD 12FT BLACK 1 EA 1 3.94 3.94
4' 460902 ZEBRA SARASA RT GEL ASST 10PK 1 PK 1 9.78 9.78
5 143297 STAPLES #64-RBBR BNDS 1/4 LB 1 PK 1 .48 .48
6 901628 FOCUS NOTES 1SUB7 NTBK11X9 100 2 EA 2 3.24 6.48
7 831602 STAPLES MED BINDERCLIPS 24CT 1 PK 1 2.31 2.31
8 451246 GE 8FT INDR EXT CORD GRAY 1 EA 1 4.40 4.40
10 634797 DRY ERASE ERASER 1 EA 1 1.83 1.83
11 753170 CASIO DESKTOP DISPLAY CALC 1 EA 1 8.09 8.09
12 517730 INDEX CARD RULD 1 SIDE 4X6 WE 1 PK 1 .91 .91
13 382955 MOUSE PAD BK 1 EA 1 1.90 1.90
14 862287 LOGITECH -M100 MOUSE BLK 2 EA 2 8.26 16.52
15 652595 STAPLES BLK GEL MOUSE REST 1 EA 1 6.39 6.39
16 831594 STAPLES SM BINDERCLIPS 40CT 1 PK 1 .77 .77
17 521062 STPLS MINI BIND 60CT CLPS 1 PK 1 .80 .80
18 356654 DUST-OFF 7 OZ 2 PACK 1 PK 1 10.95 10.95
19 512658 PAD FOLLOW UP VM LOG BOOK 1 EA 1 4.50 4.50
-- ....... - - - - - -- ------ ---------------------------------------------------
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Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks a able to Staples Advantage, Dept DET PO Box 83689, chica 0 IL 60696-3689
=BY-
3/28/15 DET 1061088 8033805110
R 'EYE TRAS fx� �, f A[YIOi4/27/15 Net 30 Days 743.93
1"010E DETAIL
Staples Advantage - Federal ID #:04-3390816
Hill to Account: 1030597 Ship to Account: 1235 CNTRL PK E
CARMEL CLAY PARKS AND RECREATION CITY OF CARMEL
PAULA SCHLEMMER ATTN: LINDA ACOSTA '
1411 E 116TH ST 1235 CENTRAL PARK DR E
CARMEL, IN 46032 DLV BEFORE 4PM
' CARMEL, IN 46032
Budget Ctr 1081-99-4230200 ESE ADMINISTRATION Invoice Number: 3261311723
Budget Ctr Desc: order. 71339.96108-000-001
P O Number xx-1892 Ordered By DAWN KOEPPER
P 0 Desc order Date 3/25/15
Release
Release Desc
order order B/o unit ship unit Extended
Line Item Number Description Qty Qty Meas Qty Price Price
20 901641 FOCUSNOTES STENO BOOK 6X9 5 EA 5 1.77 8.85
21 525915 CLIP PAPER STL #3/.031 4 BX 4 .50 2.00
22 752602 KLEENEX ANTI-VIRAL FACE TISSUE 1 PK 1 5.56 5.56
Freight: .00 Tax:( .0000 %) .00 Sub-Total: 131.53
Total: 131.53
- - -- ------- ----- -- - - - -- -- --- - - - - - - - - - - ----- ---
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customer Service inquiries ,1877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 2
Make checks a able to Ste les Advantage, Det DET PO Box 83689, Chico o IL 60696-3689
:r = 1V �
APR '10 2015 zn�voe ;, fiuroT ���� � :" �'Rr } ose
3/28/15 DET 1061088 8033805110
— ---- — LEAFPA' ' R, ¥A rA` UNtir7 , �
4/27/15 Net 30 Days 743.93
IWOICE DETAIL
staples Advantage Federal ID #:04-3390816
Bill to Accounts 1030597 Ship to Account: 1235 CNTRL PK E
s_
CARMEL CLAY PARKS AND RECREATION CITY OF CARMEL
PAULA SCHLEMNER - ATTN: ANNE MARIE BESSLER
1411 E 116TH ST 1235 CENTRAL PARK DR E
CARMEL, IN 46032 DLV BEFORE 4PM _
CARMEL, IN 46032
ssss�
Budget Ctr 1091-4230200 MCC ADMINISTRATION Invoice Number: 3261311724
Budget Ctr Desc: order 7133913115-000-001
P O Number 38247 Ordered By ANNE MARIE BESSLER
P 0 Desc Order Date 3/25/15
Release
Release Desc
order order B/o unit ship unit Extended
Line Item Number Description Qty Qty Meas Qt Price Price
1 502654 GOO GONE 1OZ 1 EA 1 1.41 1.41
2 565282 OFFICESUITES MONITOR RISER 1 EA 1 31.33 31.33
4 652149 SPLS 9X12 ECON CLIPBRD 2PK BLK 1 PK 1 7.06 7.06
5 569264 SLIM CLIPBOARD STORAGE BOX 1 EA 1 8.87 8.87
6 873986 POST-IT 4X6 ULTRA LINED 3PK 1 PK 1 7.82 7.82
7 489808 ORGANIZER DESK MULTIPOCKET BLK 1 EA 1 6.99 6.99
8 285007 BLACK #646 DESK STAPLER 1 EA 1 12.99 12.99
10 164068 SEAGATE EXPANSION DESK 4TB 1 EA 1 169.99 169.99
11 114132 ELDON HOT FILE STARTER SET SMK 1 ST 1 33.07 33.07
13 374815 1 IN WHITE SIMPL`/ VIEW BINDER 4 EA 4 1.54 6.16
14 525949 CLIP PAPER NONSKD STL GIANT 5 BX 5 .48 2.40
16 554359 EXPO LO CHISEL ASSORTED 12PK 1 PK 1 12.03 12.03
Freight: .00 Tax:( .0000 %) .00 sub-Total: 300.12
Total: 300.12
_ - ---------------------- - - ----- - - ---- --- --------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------::
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Customer service inquiries 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks a able to St les Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
'. � T1�VDICE; TE�sGUSTONIER,_ .-` s1a�Sl�N1MARVr!VOICE'
3/28/15 DET 1061088 8033805110
7APR 1 0 2015 P�EasEA. a T;ERMssbun�r uE
Aw ,r
. 4/27/15 Net 30 Days 7431.93
INVOICE DETAIL _
Staples Advantage Federal ID #:04-3390816
Bill to Account: 1030597 Ship to Account: 1235 CNTRL PK E
s
0
CARMEL CLAY PARRS AND RECREATION CITY OF CARMEL
PAULA SCHLEMMER ATTN: ANNE MARIE BESSLER
1411 E 116TH ST 1235 CENTRAL PARK DR E
CARMEL, IN 46032 DLV BEFORE 4PM
CARMEL, IN 46032
m
Budget Ctr 1091-4230200 MCC ADMINISTRATION Invoice Number: 3261311725
Budget Ctr Desc: order 7133913115-000-004
P O Number 38247 Ordered By ANNE MARIE BESSLER
P 0 Desc Order Date 3/25/15
Release
Release Desc
order order B/a unit ship unit Extended
Line Item Number Description Qty Qty Meas Qty Price Price
15 498354 LGLPAD 5X8 FASH NRW W BRDR 4PK 1 PK 1 5.69 5.69
Freight: .00 Tax:( .0000 %) .00 sub-Total: 5.69
Total: 5.69
----------------------- - -.......---------....._.._..------------------....-------.............------------------------------------------------------- .........---- ----------------- - - -----------------------------------------------.....----------------......-------------------------------------------------
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Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks a able to St les Advantage, Dept DET PO Box 83689, chic. o IL 60696-3689
1
APR 10 2015 INul I E Dh 7 40 k0 &"+ "�in►MA� NvolC
3%28/15 DET 1061088 8033805110
4/27/15 Net 30 Days 743193
INVOICE DETAIL
staples Advantage Federal ID #:04-3390816
Bill to Account: 1030597 Ship to Account: 1411 8 116TH ST
CARMEL CLAY PARRS AND RECREATION CITY OF CARMEL
PAULA SCHLEM14ER ATTN: DAWN KOEPPER
1411 E 116TH ST 1411 E 116TH ST
CARMEL, IN 46032 CARMEL, IN 46032
Budget Ctr 1125-100-010-4230200 ADMINISTRATION Invoice Number: 3261311726 �■
Budget Ctr Desc: Order 7133993343-000-001 _
P 0 Number XX-1891 ordered By DAWN KOEPPER -
P 0 Desc order Date 3/25/15
Release
Release Desc
order order B/o unit ship unit Extended
Line Item Number Description Qty Qty Meas Qty Price Price
1 135848 STAPLES 8.5X11 COPY CS 3 CT 3 39.60 118.80
2 512215 SPLS 11X17 COPY CS 1 CT 1 45.10 45.10
Freight: .00 Tax:( .0000 %) .00 sub-Total: 163.90
Total: 163.90
3
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Customer Service inquiries # 871-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks a able to St les Advantage, Det DET Po Box 83689, Chica o IL 60696-3689
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
361528 Staples Business Advantage Terms
Dept DET 2368
P.O. Box 83689
Chicago, IL 60696-3689
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
3/28/15 3261311721 Markers WB xx1870 $ 40.88
3/28/15 3261311722 Site Plan 4 supplies xx1875 $ 101.81
3/28/15 3261311723 ESE Office supplies xx1892 $ 131.53
3/28/15 3261311724 MCC office supplies 38247 $ 300.12
. 3/28/15 3261311725 MCC office supplies 38247 $ 5.69
3/28/15 3261311726 Copy paper xx1891 $ 163.90
Total $ 743.93
1 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.
361528. Staples Business Advantage. Allowed- :20
Dept DET 2368
P.O. Box 83689
Chicago,"IL: 60696-3689 In SUM of.$
_ - �`
$ - 743.93
ON-ACCOUNT-OF:APPROPRIATION FOR "
101 General Fund-/108-ESE/109 Monon Center ti ,
Po#or. .Board Members-.
OICE NO. ACCT#/TITLE -' AMOU
INVNT i
Dept#... _.
.1082-3- 3261.311.721 4239039 $ 40.88 �' 1 hereby certify that the attached invoice(s), or _.
1081-8 3261"311,722:: , 4239039, bill(s)is(are).�true:and correct and that the .
1081-99- - 326131/723 423020Q.,- $ 131:53 �' mate'rials`or services itemized thereon for
1,0:91= ', '-,326181 1724 4230200 $. 300.`12_ which'cha'rge is made were-ordered'and.
1091 326131-1725 4230200 $ _ : 5:69'.: .'
received except
11263261311726 4230200 $ 163.90" .
April,16;2015 .
. _ I
:..
. Signature
$ 74$.01 Accounts Payable coordinator.
Cost-distnbution ledger classification if.: Title
claim paid'motor vehicle highway fund i.
INVOICE DATE ' ' CUSTOMER SUMMARYINUOIC.E
4/04/15 DET 1061088 8033907886
5/04/15 Net 30 Days 146.33
I"OICE DETAIL
Staples Advantage Federal ID #:04-3390816
Bill to Account: 1030382 Ship to Account: 1 CIVIC SQUARE
0
CITY OF CARMEL-NJPA CITY OF CARMEL
JIM SPELBRING ATTN: ANN DAVIS
1 CIVIC SQUARE 1 CIVIC SQUARE
CARMEL, IN 46032 DELIVER BY 4PM
CARMEL, IN 46032
Budget ctr 140 - COMMON COUNCIL invoice Number: 3262319734
Budget Ctr Desc: Order 7134411707-000-001
P 0 Number Ordered By ANN DAVIS
P 0 Desc Order Date 4/02/15
Release
Release Desc
order order B/0 Unit ship Unit Extended
Line Item Number Description Qty Qty Meas Qty Price Price
1 125328 SHARPIE FINE PERM BLACK 12/DZ 1 DZ 1 5.22 5.22
2 592684 MARK-IT CHSL PERM MARKER 4 BLK 3 PK 3 3.79 11.37
4 356652 DUST-OFF 7oZ. 6 PK 1 PK 1 46.52 46.52
5 674106 LYSOL SANITIZNG WIPE CITRUS110 2 PK 2 6.31 12.62
6 483018 BIC WITE-OUT CORECTION TAPE 10 2 PK 2 21.59 43.18
Freight: .00 Tax:( .0000 %) .00 sub-Total: 118.91
Total: 118.91
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customer service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET Po Box 83689, Chicago IL 60696-3689
INV tCE BATE t ClJST4MER NfF� SUINMARY fNVDICE
� a 4/04/15 DET 1061088 8033907886
RLEASE PAYBY1 ``ZERMSy " P4 ��,m z�"�AMQU�UT DUE � ,•_
5/04/15 Net 30 Days 146:33
IWOICE DETAIL
Staples Advantage Federal ID #:04-3390816
0
Bill to Account: 1030382 Ship to Account: 1 CIVIC SQUARE
CITY OF CARMEL-NJPA CITY OF CARMEL o
JIM SPELBRING ATTN: ANN DAVIS
1 CIVIC SQUARE 1 CIVIC SQUARE
CARMEL, IN 46032 DELIVER BY 4PM
CARMEL, IN 46032
Budget ctr 140 - COMMON COUNCIL Invoice Number: 3262319738
Budget Ctr Desc: order 7134411707-000-002
P 0 Number Ordered By ANN DAVIS
P O Desc Order Date 4/02/15
Release
Release Desc
order order B/o unit ship Unit Extended
Line Item Number Description Qty Qty Meas Qty Price Price
3 453980 MEMOREX 10OPK CD-R SPINDLE 1 PK 1 27.42 27.42
Freight: .00 Tax:( .0000 %) .00 sub-Total: 27.42
Total: 27.42
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Customer Service inquiries # 877-826-7755 Invoice Payment inquiries 888-753-4104 Page: 1
Make checks iyable to Sta les Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Forth No.201(Rev.1995)
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))
vU /�
Total
I hereby certify that the attached invoice(s), or bill(s), is (are)true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
�f) ArD
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I hereby certify that the.attached invoice(s),
7 ?j0Z �� ( 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
�I
20
i
Signatur
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund