252556 12/15/15 ��,.�,qMf CITY OF CARMEL, INDIANA VENDOR: 359016
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ONE CIVIC SQUARE KAREN BREEDLOVE CHECK AMOUNT: S"""""""125.00*
:, a� CARMEL, INDIANA 46032 520 SUPER STAR CT CHECK NUMBER: 252556
9M�itiri�O` CARMEL IN 46032 CHECK DATE: 12/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 125.00 OTHER EXPENSES
Cleaning Invoice
Week Date Fee Place
12/1.2015 125.00 Water Dist. Office
to
Please Remit to:
Michelle Breedlove
Backflow Prevention -Cross-Connection Control
Carmel Water Dist. Office
3450 W 131st Street
Cannel, IN 46074
(317) 733-2845
Total Due: 125.00
I
MiclIelle Breedlove
7255 Testimony Ave
3D
Cannel, In 46033
317-281-1463
48
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
359016
BREEDLOVE, MICHELLE Purchase Order No.
DISTRIBUTION Terms
Due Date 12/8/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/8/2015 121015 $125.00
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
Date Officer
VOUCHER # 153780 WARRANT # ALLOWED
359016 IN SUM OF $
BREEDLOVE, MICHELLE
DISTRIBUTION
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
121015 01-6360-06 $125.00
Voucher Total $125.00
Cost distribution ledger classification if
claim paid under vehicle highway fund