250107 1 0/07/1 5 .y -Mf CITY OF CARMEL, INDIANA VENDOR: 365322
`� 2. CHECK AMOUNT: $*******300.00*
ONE CIVIC SQUARE JOHN W ADAMS
:i ,?� CARMEL, INDIANA 46032 12638 ROYCE COURT CHECK NUMBER: 250107
9y.,.__, CARMEL IN 46033 CHECK DATE: 10/07/15
.. ��ON�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4343004 300.00 TRAVEL PER DIEMS
Meeting Dates co=> 7/7/2015 7/21/2015 8/4/2015 8/18/2015 9/1/2015 9/15/2015 Total to
July-Sept Comm PC Comm PC Comm PC Be Paid
Names
Hal Espey- Media Tech no yes no yes no yes
i
("Adams,_John W:: $ 75.00 $ 75.00 $ - $ - $ 75.00 $ 75.00 $ �. 300.00
V 7 75.00 75.00 75.00 75.00 75.00 450.00
Casati, Michael $ 5 00 $ $ $ $ $ $
Grabow, Brad $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 450.00
Kestner, Nick $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 450.00
Kirsh,Joshua v $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 450.00
Lockwood Dennis 75.00 - 75.00 75.00 75.00 75.00 $ 375.00
Moehl,Tim V $ 75.00 $ - $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 375.00
Potasnik,Alan / $ 75.00 $ 75.00 $ - $ 75.00 $ 75.00 $ 75.00 $ 375.00
Strom uist Steve $ - $ 75.00 - 75.00 - - $ 150.00
Westermeier, Susan $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ 75.00 $ - $ 375.00
Rider, Kevin yes yes yes yes yes yes
Hollibaugh, Mike yes yes yes yes yes yes $ 3,750.00
VOUCHER NO. WARRANT NO.
ALLOWED 20
John Adams
IN SUM OF$
I
12638 Royce Court
Carmel, IN 46033
$300.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT ,, Board Members
1192 43-430.04 $300.00'
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
v
Monday, October 05,2015
Director
Title
I,
C,
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
10/06/15 $300.00
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