320047 12/21/17 CITY OF CARMEL, INDIANA VENDOR: 370354
Q it ONE CIVIC SQUARE JACOB QUINN CHECK AMOUNT: $*******138.67*
a4 CARMEL, INDIANA 46032 CITY OF CARMEL CHECK NUMBER: 320047
�MiroN,co, CLERK TREASURER'S OFFICE CHECK DATE: 12/21/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4340600 TRAVEL 100.74 RECORDING FEES
1701 4343004 TRAVEL 37.93 TRAVEL PER DIEMS
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE-'PAYABLE-VOUCHER'UCHER
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
7�6 (A Purchase Order No.
'o Cn oTerms
Date;Due: -
-invoice Invoice Description.. Amount
Date Number (or note attached invoice(s) or bill(s))
-(j5-1-T
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 4
Page 1 of I
�
Uamilton County Recorder
Jennifer Your Receipt
12/15/2017 O2:22:56P Trans #: 000838964
uus_inpss Date: 12/15/2017 Rec By: TK8
2017061648 AGREEMENT 02:'2:56P
Subtotal: $25.00
Receiot Total: $25.OD
10
yaid Dy Amount Ref
CC ,$25.00 /
JACOB W QUlNN ' ou/wm,JAcoa
~~~~~~~rom
Xcvd From: JACOB WQUINN �
$72.24
of $3=50 will
Location Quantity Order m Total Amount
, 2 70060528 $70.00
Thank You ` Nome JACOB QUINN
~m2.24
Signature
Transaction Fees are Non-Refundable
}thpm 12/15/2017
Prescribed by State Board of Accounts
MILEAGE CLAIM ,, /�\4 — TO jAZ e)
` 1 (Governmental Unit)
�Ck5'U KC On Account of Appropriation No. for
(Office,Board,Department or Institution)
DATE FROM TO ODOMETER READING* NATURE OF BUSINESS AUTO MILE
20 l Point Point Start Finish TRAVELE
f) rC i
0\1 carmd Cle ,rV-LX 5 i t'h C i
l motion C-0Ar d- i'e. c✓1
of l ut 1 ! a C'! In C` '0 14 zA-
2 -14$ i e.{MrC CPAW 0 1AW1 t i r
I + I N\ (�PIA *Yc + Cc { 3 .
2 - M-) ViewMoa�.o CkV\*t( rt , 3
?� k A'q1V'I 140Q C Nit c - r fZQc OC Lo-eve . D
oun ecod tr rkqr� >InCov\,Aewdtr Ubcuftfnt24:LLft4 91 +f4
t
i
Auto License No. TOTALS
*SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953, 1 hereby certify that the foregoing account is just and correct,that the amount claimed is legally due, after
allowing all just credits,
and that no part of the same has been paid.
Date