248644 08/25/15 • '� �,q,f.- CITY OF CARMEL, INDIANA VENDOR: 369750
js it ONE CIVIC SQUARE ADAM AASEN CHECK AMOUNT: $ ...""100.00`
CARMEL, INDIANA 46032 9520 NORA LANE CHECK NUMBER: 248644
INDIANAPOLIS IN 46032 CHECK DATE: 08/25/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 100.00 GAZEBO REFUND
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form 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
f�
ROC�Gt�Alk? / �Q-S Purchase Order No.
Cf a�Z C� /\JO r-cL tea-n Terms
`j " " L X0.3 ,� Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total ' j DYJ
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
IN SUM OF $
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ON
ON ACCOUNT OF APPROPRIATION FOR
-
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ReSuill 04
Board Members
PO#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
ID / 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
20
Signatur
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund