246396 06/1 7/1 5 \�. CITY OF CARMEL, INDIANA VENDOR: 00352774
® ; ONE CIVIC SQUARE JORDAN KLEINSMITH CHECK AMOUNT: $********34.17*
CARMEL, INDIANA 46032 C/O WASTEWATER CHECK NUMBER: 246396
'MUTON ; C/o WASTEWATER CHECK DATE: 06/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 34.17 OTHER EXPENSES
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Licensee: Jordan J. Kleinsmith
License Number: WWO15515
Authorization Code: 02870R
Received Date: 5/28/2015 9:18:48 AM
Transaction ID: 38350840
Credit Card Number: XXXX XXXX
XXXX 2096
Fee Amount: $30.00
Enhanced Fee: $2.50
Instant Fee: $1.67
Total Payment: $34.17
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https://mylicense.in.gov/eGov/PaymentResult.aspx?answer processed&credit card numb... 5/28/2015
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VOUCHER # 155667 WARRANT # ALLOWED
T9971 IN SUM OF $
KLEINSMITH, JORDAN
WASTEWATER
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
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Board members
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PO# INV# ACCT# AMOUNT Audit Trail Code
KLEINSMITH 01-7042-05 $34.17
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Voucher Total $34.17
' Cost distribution ledger classification if
claim paid under vehicle highway fund
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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
T9971
KLEINSMITH, JORDAN Purchase Order No.
WASTEWATER Terms
Due Date 6/4/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/4/2015 KLEINSMITH $34.17
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