250642 10/21/15 q'*F CITY OF CARMEL, INDIANA VENDOR: 369964
® it ONE CIVIC SQUARE TAMMIE DICKERSON CHECK AMOUNT: $" "''500.00'
s.. ?� CARMEL, INDIANA 46032 20110 S.MULLED CHECK NUMBER: 250642
*row�� BELTON MO 64012 CHECK DATE: 10/21/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
854 367009 CANVAS AWAR 500.00 CARMEL ON CANVAS
CITY OF VSEL
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: �Q'vl1 Nt i V rck, ''s
Mailing Address: .2-0 Ito S - mal-c-► ad
City, State, Zip: FWILA4 M,0 (.040 1 Z
Phone Number: 916y S 91t— 91D!O-j
Email Address: -IU1114duI-Ldifck-e, rte.a' ` C"."
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 151 and 3"'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 snail 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: Cju 7-Le a"
Awarded(category/place): Art Type(Oil/Acrylic/watercolor):
Amount of Award: i ec O • 00
ONE CIVIC SQUARE, CARMEL, IN 46032 PHONE 317.571.240 1, FAx 31 7.844.3498
EMAIL jbrainard@carmel.in.gov
Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
I
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 $500.00
t
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
Tammie Dickerson
IN SUM OF $
20110 S. Mulled
Belton, MO 64012
$500.00
ON ACCOUNT OF APPROPRIATION FOR
Community Relations Gift Fund 854
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
854 I Award Letter I Carmel on Canvas I $500.00 1 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
Monday, October 19, 2015
122^
Director, Community Welations/Economic Development
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund