316816 10/06/17 CITY OF CARMEL, INDIANA VENDOR: 120301
ONE CIVIC SQUARE HAMILTON COUNTY TREASURER CHECK AMOUNT: $*****9,775.00*
r CARMEL, INDIANA 46032 C/O HAMILTON CO AUDITOR CHECK NUMBER: 316816
•,,,`rON 1 HAMILTON COUNTY SQUARE CHECK DATE: 10/06/17
NOBLESVILLEIN 46060
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 SEPT 9,775.00 OTHER EXPENSES
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PRESCRIBED BY STATE BOARD OF ACCOUNTS CITY AND TOWN FORM 217 CT(1997)
REPORT TO COUNTY AUDITOR OF COURT COSTS
COLLECTED IN CITY/TOWN COURT
To the Auditor of Hamilton County, Indiana
I, Christine Pauley, City Officer of the City of Carmel, Indiana, hereby certify that I have received the
following amounts of the court costs payable to the County:
For the month ending SEPTEMBER 30, 2017.
ITEMIZATION COLLECTIONS PRIOR YEAR TO DATE
THIS PERIOD COLLECTIONS
$9,775.00 $87,060.38 $96,835.38
COURT COSTS:
TOTAL AMOUNT COLLECTED $9,775.00 $87,060.38 $96,835.38
Dated , 2017
i
Ci -Fiscal Office
NOTE—Mail To:
Hamilton County Auditor
One Hamilton County Square
Noblesville, IN 46060
(Make check payable to Hamilton County Treasurer)
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
�
•-�n i1
1 L-601 Purchase Order No. 1016
T1 Wil I I Ul\ lkpouqx Terms
�D N&W Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5 rM-7soo
1
Total
I 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
20Clerk-Treasurer