250563 10/21/15 CITY OF CARMEL, INDIANA VENDOR: 363882
d i ONE CIVIC SQUARE MIKE AINLEY CHECK AMOUNT: $ .....100.00"
CARMEL, INDIANA 46032 1474 CLEARWATER CT CHECK NUMBER: 250563
CARMEL IN 46032 CHECK DATE: 10/21/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 REFUND GAZ 100.00 OTHER EXPENSES
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
1� /
c_ � Purchase Order No.
�7 7`7' C�eaJ'GtJ�—�eT C.7' Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
41 - /�
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.
120—
Clerk-Treasurer
20Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
/474
ON ACCOUNT OF APPROPRIATION FOR
o/ �,'iiil -
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
1,9 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