331928 11/07/18 CITY OF CARMEL, INDIANA VENDOR: 241253
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ONE CIVIC SQUARE PETTY CASH CHECK AMOUNT: $********68.72*
CARMEL, INDIANA 46032 C/O DOCS CHECK NUMBER: 331928
M�roN.�• CHECK DATE: 11/07/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4230200 38.75 OFFICE SUPPLIES
1192 4239012 19.97 SAFETY SUPPLIES
1192 . 4343001 10.00 TRAVEL FEES & EXPENSE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor#' 241253 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PETTY CASH IN SUM OF$ CITY OF CARMEL
C/O DOCS 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
$68.72
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Dept of Community Service Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
Hohlt 42-390.12 $19.97 1 hereby certify that the attached invoice(s),or 8/3/18 Hohlt First aid kit for Mast vehicle $19.97
1192 101 1192 101
Motz 42-302.00 $19.88 bill(s)is(are)true and correct and that the 8/9/18 Motz AN cord for computer monitor $19.88
1192 101 materials or services itemized thereon for 1192 101
Hollibaugh 43-430.01 $10.00 9/20/18 Hollibaugh Parking for US 31 Coalition Meeting- $10.00
1192 101 which charge is made were ordered and 1192 101 Hollibaugh
Shestak 42-302.00 $18.87 received except 10/3/18 Shestak Notary Application for Shestak $18.87
1192 101 1192 101
Friday, November 02,2018
Mike Hollibaugh
Director
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
, 20—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Payment Result Page 1 of 1
Application Submitted 1(L
Your application has been submitted and all fees have been applied to your credit card. Please print this page as
your proof of submission and receipt of payment.
plication Information
Date Submitted: 3 October 2018
Applicant Name: Joseph Shestak
License Number: Pending
Agency: HPB
Process: Apply for Initial License process
Payment Information
Authorization Code: 06805C
Received Date: 10/3/2018 3:42:28 PM
Transaction M 94102222
---- Credit-Card-Number-. --. -- - -XXXX-XX-XX-XXXX XXXX- ------ ---- -- -- -- ---- - -- - - -
Fee Amount: $15.00
ServiceFee: $2.50
Instant Fee: $1.37
Total Fee: $18.87
https://mylicense.in.gov/eGov/PaymentResult.aspx?answer=processed&payment_id=2786... 10/3/2018
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98'5!') NORP-I MICHIGAN R11
CAMEL, IN 46032 (317)870--7680 -
20'17 00056 82521 08/03/18 12:04 Pm
SH.1- CHECK OUT
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:.!M FfRS'I AID K11- 118 PCS
51.)BIOTAL 11797?
SALFS TAX
I AV D(0111 r
TOTAL.
CASH
CASH 5.00
CASH .5.00
CASH 5.00
CFIANGF DUE 0.03
20".37 56 6.,`521 08/03/2018 9309
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Walmart
317-844-0096 Msr:KYLE LANGSTON
2001 E 151ST ST
CARMEL IN 46033
ST# 01601 OP# 002035 TE# 17 TR# 07438
HDMI ADAPTOR 068113101491
SUBTOTAL 19.88
TAX 1 7,00
TOTAL 21 .27
DEBIT TEND 21 .27
CHANGE DUE 0.00
EFT DEBIT PAY FROM PRIMARY
21 .27 TOTAL PURCHASE
US DEBIT- 6135 I 0 REF # 822100740156
NETWORK ID. 0056 APPR CODE 242683
US DEBIT
AID A0000000980840
TC 1E38EBO4D991FOF3
*Pin Verified
TERMINAL # MX328509
08/09/18 16:57:13
# ITEMS SOLD 1
TC# 7421 402!1 29414 7962 9445! I
08/09/18 16:57:17
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