249897 09/23/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 369874
ONE CIVIC SQUARE RAYMOND SMITH CHECK AMOUNT: S""'*""216.50`
CARMEL, INDIANA 46032 13178 PLAYER CIRCLE CHECK NUMBER: 249897
CARMEL IN 46033 CHECK DATE: 09/23/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 216.50 WEED REFUND
x.
City of Carmel Invoice No. 8615
One Civic Square
Carmel, IN 46032
317-571-2444 fax 317-571-2499 ++
INVOKrL
Customer
Name Raymond Smith Date 7/30/2015
Address 13178 Player Cir Order No,
City Carmel State IN ZIP 46033 Rep
Phone FOB
qty Description Unit Price TOTAL
1 Lawn mowing at: 13178 Player Cir Carmel $85.00
Parcel#16-10-27-00-01-016.000
2 Certified Mail -$11.5()-
3
$11.50 3 Administrative Fee $120.00
poi
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a Payment is due on: August 28, 2015
3
Please make check payable to:
City of Carmel
Mail to:
City of Carmel
Building and Code Services
Attn: Joslyn Kass
One Civic Square
Carmel, IN 46032
Total $216.50
Payment Details
I 0 Cash
0 Check
Office Use Only
City of Carmel, Department of Community Services
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
A-4y/nd-4 Purchase Order No.
/ 0'L i4YQ,r C'�2 Terms
1 ►.1 0 . �— Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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
AV, ,gym 1 7-#
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
d ��a_►90 d/fir. 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
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund