259238 05/31/16 �._Coq
v`% ;'� CITY OF CARMEL, INDIANA VENDOR: 370581
`� ONE CIVIC SQUARE WORKING WELL CHECK AMOUNT: $********16.00*
r. r CARMEL, INDIANA 46032 35332 EAGLEWAY CHECK NUMBER: 259238
9M�*oN�` CHICAGO IL 60678-1353 CHECK DATE: 05131/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 00208457-00 16.00 TESTING FEES
VOUCHER NO. WARRANT NO.
ALLOWED 20
WORKING WELL
35332 EAGLEWAY
IN SUM OF$
CHICAGO, IL 60678-1353
$16.00
ON ACCOUNT OF APPROPRIATION FOR
Human Resources
PO#/Dept. INVOICE NO. I ACCT#/Fund AMOUNT Board Member,
00208457-00 I 43-588.00 I $16.00 1 hereby certify that the attached invoice(s), or
1201 101
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
Tuesday, May 10, 2016
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
04/30/16 00208457-00 $16.00
1201 101
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
WorkingWell Invoice Page: 1
35332 Eagleway
Chicago,IL 60678-1353 Invoice No. Date
Telephone(219)873-2484 00208457 -00 04/30/2016
Bill To: Amount Due: $16.00
City Of Carmel
1 Civic Square Federal ED: 35-1835133
Carmel,IN 46032 Account: 010961
Terms: Net due in 30 days
ervIce, ate., Medical Activity a1, unit-p
'ki
A�ju,st6d, Amount
SSN:xxx-xx-1813 Kole D Bassett Clinic Code: REN
04/27/2016 Drug Scm Collect Only-NonDOT 1.00 $16.00 $16.00
Bassett
06;'
FSubMitted To
SO
Mitte" To
MAY 10 2016
Clerk Treasurer
If Paying by Credit Card,fill out below
Call 219-873-2484 with credit card payments;and billing AMEX [:] VISA D MC E]
questions.Thank You for your business. Card Number:
Account 010961 City Of Carmel Exp.Date: Sec Code:
Signature: Amount:
Remit To:
TOA'DUE 116,0W!,
TOTAL
WorkingWell
35332 Eagleway Invoice 00208457 00 Date 4/30/2016
Chicago, IL 60678-1353
Telephone(219)873-2484 Thank You