246576 06/17/15 �_; 1 CITY OF CARMEL, INDIANA VENDOR: 356491 CHECK AMOUNT: $,***#,,,,34.17,
ONE CIVIC SQUARE TARA WASHINGTON
s� %r°'. CARMEL, INDIANA 46032 4475 SILVER SPRINGS DR CHECK NUMBER: 246576
9�,, GREENWOOD IN 45142 CHECK DATE: 06/17/15
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
G51 5023990 34.17 OTHER EXPENSES
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Licensee: Tara M. Washington
License Number: WW019993
Authorization Code: 033143
Received Date: 6/10/2015 2:32:37 PM
Transaction ID: 39187130
Credit Card Number: XXXX XXXX
XXXX
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... 6/10/2015
VOUCHER # 155722 WARRANT # ALLOWED
356491 IN SUM OF $
WASHINGTON, TARA
SOUTH PLANT I.
Carmel Wastewater Utility
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ON ACCOUNT OF APPROPRIATION FOR !�
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Board members
PO# INV# ACCT# AMOUNT Audit Trail Code j
WASHINGTO 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
356491
WASHINGTON, TARA Purchase Order No.
SOUTH PLANT Terms
Due Date 6/10/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/10/2015 WASHINGTC $34.17
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-5-1 1-10-1.6
J
Date Officer