246891 06/30/1 5 r Cqq*f
^..'' CITY OF CARMEL, INDIANA VENDOR: 369515
b ONE CIVIC SQUARE STACIA MATTHEWS CHECK AMOUNT: $ .....100.00"
CARMEL, INDIANA 46032 INDIANA SPINE GROUP CHECK NUMBER: 246891
13225 N MERIDIAN ST CHECK DATE: 06/30/15
CARMEL IN 46032
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 100.00 GAZEBO DEPOSIT
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
�n Qt I'A-YNR+,_/ r h t° ' act Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (� (or note attached invoice(s) or bill(s))
lo-ZS-� j�'�7'cJ h � a►'' �Q✓� Ge.� (�,'F'��� v► 0 � � � Q�
Total 1 4
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
20Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
^e--- rt"� IN SUM OF $
en ; Sf
-'16,03Q9�
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
SEPT.# 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
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund