250031 10/06/15 CITY OF CARMEL, INDIANA VENDOR: 369921
® I ONE CIVIC SQUARE LESLEY HAFLICH CHECK AMOUNT: $*******100.00*
CARMEL, INDIANA 46032 206 YORKSHIRE CIRCLE CHECK NUMBER: 250031
NOBLESVILLE IL 46060 CHECK DATE: 10/06/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
854 4359025 100.00 OTHER EXPENSES
A6t4 0- 1
t r
CI'T'Y ®F C`� EL
JAMES BRAINARD, MAYOR
September 19,2015
Carmel on Canvas Award Winner
We would like to congratulate on your recent win at our Carmel on Canvas event!
To receive your award for this event,the City of Carmel does require a W-9 to be on file before a
check can be issued.Therefore we will need for you to fill out the attached W-9 form along with
including your contact information(name,,-address,phone number, etc.).
Name: ��[" -(�1:��� CAVI
Mailing Address: 6LO G `/ow" W &6 6"'x.01 e1_(
City,State,Zip: fdolovSsv(I Lel ( �� �60�a
Phone Number: 'j Iq—5Z Z5
Email Address:
NOTE: Once the City receives this information,they will start the claim's process,which will
require City Council approval.The City Council approves claims on the 1"and 3rd Monday of the
month for claims that were turned in for the week prior. Therefore the check will not be available
immediately and could take a couple of weeks before it is ready.We will mail these checks to you,
at the address referenced above,as soon as they are available
Congratulations again!
City of Carmel
Mayor's Office
317-571-2401
INTERNAL USE:
Awarded(category/place): Art Type(Oil/Acrylic/watercolor):
Amount of Award:
ONE CIVIC SQUARE,CARMEL, IN 46032 PHONE 317.571.240 1, FAx 317.844.3498
EMAIL jbrainard@carmel.in.gov
VOUCHER NO. WARRANT NO.
ALLOWED 20
Lesley Haflich
IN SUM OF$
206 Yorkshire Circle
Noblesville, IN 46060
r
$100.00
ON ACCOUNT OF APPROPRIATION FOR
Community Relations Gift Fund 854
PO#/Dept. INVOICE NO. ACCT#lrITLE AMOUNT Board Members
854 I Award Letter I Arts District Festivals I $100.00 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
Sunday,September 27,2015
Director, Community Relations/Economic Development
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
i
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))
09/19/15 Award Letter $100.00
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