248802 08/26/15 �"r CLAM
CITY OF CARMEL, INDIANA VENDOR: 085325
ail ONE CIVIC SQUARE STEVE ENGELKING CHECK AMOUNT: $""*'"200.00'
f. CARMEL, INDIANA 46032 6221 WINFORD DR CHECK NUMBER: 248802
INDIANAPOLIS IN 46236 CHECK DATE: 08/26/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4358500 200.00 CENSUS & ELECTION FEE
8/24/2015 i 7O 5�/� Pay.gov-Receipt
Receipt
Your payment is complete
Pay.gov Tracking ID: 25NOSMRI
Agency Tracking ID: 74860880936
Form Name: Special Census Cost Estimate PUBLIC FORM
Application Name: Data Sales Interface
Payment Information
Payment Type: Debit or credit card
Payment Amount: $200.00
Transaction Date: 08/24/2015 09:03:38 AM EDT
Payment Date: 08/24/2015
Account Information
Card Holder Name: Stephen C Engelking
Billing Address: 6221 Winford Drive
Billing Address 2:
City: Indianapolis
Country: .
State/Province: Indiana - IN
ZIP/Postal Code: 46236
Card Type:
Card Number: ************
Email Confirmation Receipt
Confirmation Receipts have been emailed to:
sengelking@carmel.in.gov
Submitted. To
AUG 2 4 W5
[:ark `Treasurer
https:/Mrww.pay.gov/public/colleebori/confirm/prinY25NOSMRI 1/1
Engelking, Steve C
From: notification@pay.gov
Sent: Monday, August 24, 2015 9:04 AM
To: Engelking, Steve C
Subject: Pay.gov Payment Confirmation: Data Sales Interface
Your payment has been submitted to Pay.gov and the details are below. If you have any questions regarding this
payment, please contact Sharon Curry at(301) 763-9567 or Sharon.m.curry@census.gov.
Application Name: Data Sales Interface
Pay.gov Tracking ID: 25NOSMRI
Agency Tracking ID: 74860880936
Transaction Type:Sale
Transaction Date:08/24/2015 09:03:38 AM EDT
Account Holder Name:Stephen C Engelking
Transaction Amount: $200.00
Billing Address: 6221 Winford Drive
Billing Address 2:
City: Indianapolis
State/Province: Indiana - IN
Zip/Postal Code:46236
Country:
Card Type:Visa
Card Number: ************1010
THIS IS AN AUTOMATED MESSAGE. PLEASE DO NOT REPLY.
i
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
08/24/15 25NOSMRI Reimbursed Special Census Cost Estimate $200.00
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.
ALLOWED 20
Engelking, Steve
IN SUM OF $
$200.00
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 25NOSMRI 43-585.00 $200.00
I hereby certify that the attached invoice(s), or
I I
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, August 24, 2015
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund