251905 1 2/02/1 5 CITY OF CARMEL, INDIANA VENDOR: 00353333
® 4`; ONE CIVIC SQUARE JEAN BELCHER CHECK AMOUNT: $*****1,150.00*
CARMEL, INDIANA 46032 CHECK NUMBER: 251905
M,;oN CHECK DATE: 12/02/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4341999 1524 1,150.00 OTHER PROFESSIONAL FE
I
Jean A Belcher
1745 W 136th Street
Carmel IN 46032
INVOICE FOR PROFESSIONAL SERVICES
Date of invoice: November 30, 2015 Payroll 1524
II
Dates of service: Servicesperformed: Hours Rate
November 17, 2015 Payroll processing 1.50 $100/hr
November 23, 2015 Payroll processing 3.0 $100/hr
November 24, 2015 Payroll processing 2.75 $100/hr
November 25, 2015 Payroll processing 3.25 $100/hr
November 29, 2015 Payroll processing 1.0 $100/hr
TOTAL HOURS BILLED ON THIS INVOICE 11.5
Total invoice: $1,150.00
Prescribed,by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.199
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))
- -- -- --- - I � Sys(► ? �
Total
hereby certify that the attached invoice(s), or bill(s), is (are)true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
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),
�7D l '2- —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
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I.
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20
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Signature
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Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund