179953 12/07/2009 'r CITY OF CARMEL, INDIA VENDOR: 359662 Page 1 of 1
ONE CIVIC SQUARE A T T
1
o CARMEL, INDIANA 46032 PO BOX 8100 CHECK AMOUNT: $773.66
AURORA IL 60507 -8100 CHECK NUMBER: 179953
CHECK DATE: 12/7/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4344000 317580037511 36.43 31758003751262
1110 4344000 317733200111 68.38 31773320012347
1120 4344000 317733200111 141.20 31773320012347
2201 4344000 317733200111 451.74 31773320012347
.601 5023990 317733200111 75.91 31773320012347
CITY OF CARMEL Page 1 of 1
OBA BROOKSHIRE GOLF CLUB Account Number 317 580 -0375 126 2
ATTN KEN MILLER Billing Date Nov 25, 2009
12120 BROOKSHIRE PKWY
CARMEL, IN 46033.3314 Web Site att.com a t
f Invoice Number 317580037511
ont Statement
Oct 26 Nov 25, 2009
Bill -At A- Glance., Plans and Servlces �;l�
Previous Bill 36.34
Monthly Service Nov 25 thru Dec 24
1. Monthly Charges 30.56
Payment Received 11 -12 Thank You! 36.34CR
Surcharges and Other Fees
Adjustments .00 9 -1 -1 Emergency System
Billed for Hamilton County 2.00
Balance 00 Federal Universal Service Fee .68
r +r IN Universal Service Surcharge .05
Current Charges 36.43 Telecommunications Relay System .03
Total Surcharges and Other Fees 2.76
Total Amount Due $36.43 Taxes
Federal at 3% .92
Amount Due in Full by Dec 18 2009 State at7% 2.19
Total Taxes 3.11
Total Plans and Services 36.43
Billing Summary`s l
Questions? Visit att.com 4
You Can Use r k 2,141
Plans and Services 36.43
1-800-660-3000 PREVENT DISCONNECT
Repair Service: Thank you for being a valued customer. It is important to inform you
1-800-727-2273 that all charges must be paid each month to keep your account current
For more information on products and services call and prevent collection activities. In addition, please be aware that
1 -800- 660 -3000 we are required to inform you of certain charges that MUST be paid in
order to prevent interruption of basic local service. These charges
Total of Current Charges 36.43 are already included in the Total Amount Due and are $32.36.
If you don't agree with the amount due, you should dispute the portion
you disagree with before the payment due date.
LONG DISTANCE INFO
Our records indicate thatyou have chosen not to have a
local toll or a long distance company.
PAYMENT OPTIONS
Pay bills online FREE of charge at att.com. Go There Today! Payments
made with an AT &T representative may be subject to a $5.00 payment
convenience fee. You can mail your payment in the enclosed envelope.
AT &T CREDIT CARD
The AT &T Universal Business Rewards Card gives you ThankYou® Points
when you use itto pay this bill! Plus valuable benefits to manage
your business. Learn more at business.universalcard.com offer code
PAY 1.
News You Can Use Summary �r 4 rtr:
PREVENT DISCONNECT LONG DISTANCE INFO
PAYMENT OPTIONS AT &T CREDIT CARD
See "News You Can Use for additional information.
Local Services provided by AT &T Illinois, AT &T Indiana, AT &T Michigan,
AT &T Ohio or AT &T Wisconsin based upon the service address location.
Printed on Recyclable Paper
Return bottom portion with your check in the enclosed envelope. U.S. Pat. 0410,950 and D414,510 CK7
s e l vF,� W1
Prescribed by State Board of Accounts City Form No. 261 (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.
62e Terms
jpLG c 0 /2 17- o.c" "69 d) Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
,1-c/D4 ,5 Y
Total g4,vg
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
Clerk- Treasurer
VOUCHER NO. WARRANT NO..
ALLOWED 20
IN SUM OF
PO Ocp) 47a)
4(
36, 9's
ON ACCOUNT OF APPROPRIATION FOR
6
/o7 6d 6ttics—
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT hereby certify DEPT. 1 hereb certif that the attached invoice(s), or
4:W 3/9 cS7 „i V -cz) V.5 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
1.1fir 7 20 a�
6 iji
Sin
n u r
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund
i ,nom
CITY OF CARMEL Page 1 of 1
3400 W 131ST ST Account Number 317 733 -2001 234 7
WESTFIELD, iN 46074 8267 Billing Dale Nov 19, 2009
Web Site att.com
4 at 8
AM Invoice Number 317733200111
Milont illy Staten
Oct 20 Nov 19, 2009
Bill- At- A- Glance Plans and Services .0
Previous Bill 735.30.'1- Monthly Service Nov 19 tllru Dec 18
Customer Service Record
Payment Received 1 0 -29 Thank You! 735 30CR 2 reports S5.00 ea 10.00
Monthly Charges 702.68
Adjustments 00 Total Monthly Service 712.68
Balance 00 Information Charges
411 and 555 -1212
Current Charges 737:23, "i 1 Listinglsl requested from 1+411
1 Listingls) billed at 51.79 each 1.79
Total Amount Due $737.23 Local Toll
No. Date Time Place Called Number Code Min
I ;Amount Due in Full by Dec 14, 2009 CaIIs Charged to 317 733 -2003
M
411 and 555 -1212
1 Listinglsl billed at 51.79 each
Billing Summary Surcharges and Other Fees
9 -1 -1 Emergency System
Questions? Visit att.com Billed for Hamilton County 16.00
Federal Universal Service Fee 3.22
Plans and Services 737.23 IN Universal Service Surcharge 3.43
1- 800 -480 -8088 Telecommunications Relay System .11
Repair Service: Total Surcharges and Other Fees 22.76
1- 800 727 -2273
Total Plans and Services 737.23
Total of Current Charges 737.23
;News You Can Use
PREVENT DISCONNECT
Thank you for being a valued customer. It is important to inform you
that all charges trust be paid each month to keep your account current
and prevent collection activities. In addition, please be aware that
we are required to inform you of certain charges that MUST be paid in
order to prevent interruption of basic local service. These charges
are already included in the Total Amount Due and are 5673.17.
If you don't agree with the amount due, you should dispute the portion
you disagree with before the payment due date.
CARRIER INFO
AT &T Long Distance, or a company that resells their service,
is your long distance and local toll carrier.
INDIANA URT
Effective January 1, 2010, a new surcharge will apply to local and
ntrastate charges on your bill at the rate of 1.4% per month to
News You Can Use Sumftiary F recover the Utility Receipts Tax (URT) paid by AT &T Indiana.
s For questions about this charge, please call an AT &T Service
Representative at the toll -free number on this bill. Thank you for
PREVENT DISCONNECT CARRIER INFO choosing AT &T Indiana.
INDIANA URT
See "News You Can Use' for additional information.
Local Services provided by AT &T Illinois, AT &T Indiana, AT &T Michigan,
AT &T Ohio or AT &T Wisconsin based upon the service address location.
Tip Printed on Recyclable Paper
Return bottom portion with your check in the enclosed envelope. U.S. Pat, 0410,950 and 0414,510 NN
5vs a "v1`;',°- t
y yat CL]r11�>C� r S F r die at
f ;,t b �'s ..w..
This is a summary of the SBC billing for 11/19/2009
Department Name Totals
CPD Garage $68.38
Fire Dept #42 $141.20
Street Dept $451.74
Water Dept $75.91
Total for the SBC Bill: $737.23
Monday, November 30, 2009 Page 1 of 1
Bill Date: 11/19/2009
Phone Number LD Charge Misc Info Line Fees Totals
CPD Garage
Location Code: AD 3400 W. 131st Street Ste. 1
733 -4600 $0.00 $0.00 $0.00 $34.189 $34.189
733 -6257 $0.00 $0.00 $0.00 $34.189 $34.189
Voice Mail: $0.00
SBC Totals: $0.00 $0.00 $0.00 $68.38 $68.38
Remit To: SBC
Bill Payment Center
Chicago, IL 60663 -0001
Monday, November 30, 2009 Page 1 of 5
Bill Date: 11/19/2009
Phone Number LD Charge Misc Info Line Fees Totals
Fire Dept #42
Location Code: AB 3610 W. 106th Street
733 -0545 $0.00 $0.00 $0.00 $32.313 $32.313
733 -0661 $0.00 $0.00 $0.00 $32.313 $32.313
733 -1480 $0.00 $0.00 $0.00 $44.263 $44.263
733 -1481 $0.00 $0.00 $0.00 $32.313 $32.313
Voice Mail: $0.0o
SBC Totals: $0.00 $0.00 $0.00 $141.20 $141.20 I
Remit To: SBC
Bill Payment Center
Chicago, IL 60663 -0001
Monday, November 30, 2009 Page 2 of 5
Bill Date: 11/19/2009
Phone Number LD Charge Misc Info Line Fees Totals
Street Dept
Location Code: AA 3400 W. 131st Street
733 -2001 $0.00 $0.00 $0.00 $48.430 $48.430
733 -2002 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2003 $0.00 $0.00 $1.79 $28.680 $30.470
733 -2004 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2005 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2006 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2007 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2008 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2009 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2011 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2012 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2013 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2014 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2062 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2153 $0.00 $0.00 $0.00 $28.680 $28.680
Voice Mail: $0.00
SBC Totals: $0.00 $0.00 $1.79 $449.95 $451.74 1
Remit To: SBC
Bill Payment Center
Chicago, IL 60663 -0001
Monday, November 30, 2009 Page 3 of 5
Bill Date: 11/19/2009
Phone Number LD Charge Misc Info Line Fees Totals
Water Dept
Location Code: AC 3450 W. 131st Street
733 -2029 $0.00 $0.00 $0.00 $37.953 $37.953
733 -2053 $0.00 $0.00 $0.00 $37.953 $37.953
Voice Mail: $0.00
SBC Totals: $0.00 $0.00 $0.00 $75.91 $75.91
Remit To: SBC
Bill Payment Center
Chicago, IL 60663 -0001
Monday, November 30, 2009 Page 4 of 5
VOUCHER NO. WARRANT NO. I Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
AT &T
IN SUM OF CITY OF CARMEL
P. 0. Box 8100 An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
Aurora, I L 60507 -8100 whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
a3 Payee
Purchase Order No.
ON ACCOUNT OF APPROPRIATION FOR
Terms
Carmel Street Department
Date Due
Invoice Invoice Description Amount
PO# 1 Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members Date Number (or note attached invoice(s) or bill(s))
2201 317733200111 43- 440.00 $451.74 I hereby certify that the attached invoice(s), or 11/19/09 317733200111 $451.74
1 I I 0 ti L 8,f3 bill(s) is (are) true and correct and that the
I I Z+r) h l NA t' )0 materials or services itemized thereon for
W a; t
which charge is made were ordered and
received except
Monday, November 30, 2009
j ag t C r' 4
Title
Street Cornmissloner
Cost distribution ledger classification if I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
claim paid motor vehicle highway fund with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
CITY OF CARMEL, INDIANA VENDOR: 359662 Page 1 of 1
ONE CIVIC SQUARE A T T CHECK AMOUNT: $773.66
CARMEL, INDIANA 46032 PO sox 8100
AURORA IL 60507 -8100 CHECK NUMBER: 179953
CHECK DATE: 12/7/2009
DEPARTMENT ACCOUNT PO NU INV OICE NU MBER A MOUNT DESCRIPTION
1207 4344000 317580037511 36.43 31758003751262
:1110 4344000 317733200111 68.38 31773320012347
1120 4344000 317733200111 141.20 31773320012347
2201 4344000 317733200111 451.74 31773320012347
.601 5023990 317733200111 75.91 31773320012347
CITY OF CARMEL Page 1 of 1
DBA BROOKSHIRE GOLF CLUB Account Number 317 580 -0375 126 2
ATTN KEN MILLER Billing Date Nov 25, 2009
12120 BROOKSHIRE PKWY
at &t CARMEL, IN 46033 -3314 Web Site att.com
Invoice Number 317580037511
M.ontNy Statement
Oct 26 Nov 25, 2009
J, AiwA7'0
Previous Bill 36.34 Monthl Service Nov 25 thru Dec 24
Monthly Charges 30.56
Payment Received 11 -12 Thank Youl 36:34CR
Surcharges and Other Fees
Adjustments .00 9 -1 -1 Emergency System
Billed for Hamilton County 2.00
Balan'ce' .00 Federal Universal Service Fee .68
IN Universal Service Surcharge .05
Current Charges '36.43 Telecommunications Relay System .03
Total Surcharges and Other Fees 2.76
Total Amount Due $36.43 Taxes
I Federal at3% -92
Amount Due in Full by Dec "18, N09 State at 7% 2.19
Total Taxes 3.11
Total Plans and Services 36.43
Questions? Visit att.com
Plans and Services 36.43
1 -800- 660 -3000 PREVENT DISCONNECT
Repair Service: Thank you for being a valued customer. Itis importantto inform you
1- 800 727 -2273 that all charges must be paid each month to keep your account current
For more information on products and services call and prevent collection activities. In addition, please be aware that
1- 800 -660 -3000 we are required to inform you of certain charges that MUST be paid in
order to prevent interruption of basic local service. These charges
Total of Current Charges 36.43 are already included in the Total Amount Due and are 532.36.
If you don't agree with the amount due, you should dispute the portion
you disagree with before the payment due date.
LONG DISTANCE INFO
Our records indicate that you have chosen not to have a
local toll or a long distance company.
PAYMENT OPTIONS
Pay bills online FREE of charge at att.com. Go There Today! Payments
made with an AT &T representative may be subject to a 55.00 payment
convenience fee. You can mail your payment in the enclosed envelope.
AT&T CREDIT CARD
The AT &T Universal Business Rewards Card gives you ThankYou® Points
when you use itto pay this bill! Plus --valuable benefits to manage
your business. Learn more at business.universalcard.com offer code
PAY 1.
PREVENT DISCONNECT LONG DISTANCE INFO
PAYMENT OPTIONS AT &T CREDIT CARD
See "News You Can Use" for additional information.
Local Services provided by AT &T Illinois, AT &T Indiana, AT &T Michigan,
AT &T Ohio or AT &T Wisconsin based upon the service address location.
Printed on Recyrla6te Paper
Return bottom portion with your check in the enclosed envelope. U.S. Pat. D410,950 and D414,510
r
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
wham, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
d O/' Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bilf(s))
Total 3
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
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
,4&
nr1�L�a� -ice
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
C 7 20 d
Signature I
Cost distribution ledger classification if Ti le
claim paid motor vehicle highway fund
CITY OF CARMEL Page 1 of 1
3400 W 131 ST ST Account Number 317 733 7
WESTFIELD, IN 46074 -8267 Billing Date Nov 19, 2009
0
at&t web site MUM
Invoice Number 317733200111
MOnth9y Statement
Oct 20 Nov 19, 2009
Bill A Plans and S6rvices
Previous Bill 735.30 i= Monthl Service Nov 19 thru Dec 18
Customer Service Record
Payment Received 10 -29 .Thank You! 735.3QCR •:j 2 reports 5,00 ea 10.00
Monthly Charges 702.68
Adjustments .00::1 Total Monthly Service 712.68
Balance 00 Information Char
411 and 555 -1212
Current Charge s 737,23 1 Listing(s) requested from 1 +411
1 Listing(s) billed at 51.79 each 1.79
Total Amount Due $737.23 Local Toll
No. Date Time Place Called Number Code Min
Amount Due in Full by Dec 14 2009 Calls Charged to 317 733 -2003
411 and 555 -1212
1 Listing( s) billed at 51.79 each
Billin Sunntpary Surchar and Other Fees
9 -1 -1 Emergency System
Questions? Visit att.com Billed for Hamilton County 16.00
Federal Universal Service Fee 3.22
Plans and Services 737.23 IN Universal Service Surcharge 3.43
1- 800 -480 -8088 Telecommunications Relay System .11
Repair Service: Total Surcharges and Other Fees 22.76
1 -800- 727 -2273
Total Plans and Services 737.23
Total of Current Charges 737.23
PREVENT DISCONNECT
Thank you for being a valued customer. It is important to inform you
that all charges must be paid each month to keep your account current
and prevent collection activities. In addition, please be aware that
we are required to inforin you of certain charges that MUST be paid in
order to prevent interruption of basic local service. These charges
are already included in the Total Amount Due and are 5673 -17.
If you don't agree with the amount due, you should dispute the portion
you disagree with before the payment due date.
CARRIER INFO
AT &T Long Distance, or a company that resells their service,
is your long distance and local toll carrier.
INDIANA URT
Effective January 1, 2010, a new surcharge will apply to local and
intrastate charges on your bill at the rate of IA% per month to
t recover the Utility Receipts Tax (URT) paid by AT &T Indiana-
For questions about this charge, please call an AT &T Service
Representative at the toll -free number on this bill. Thank you for
PREVENT DISCONNECT CARRIER INFO choosing AT &T Indiana.
INDIANA URT
See "News You Can Use" for additional information.
Local Services provided by AT &T Illinois, AT &T Indiana, AT &T Michigan,
AT &T Ohio or AT &T Wisconsin based upon the service address location.
Return bottom portion with your check in the enclosed envelope. U.S. Pat. D410.950 and 0414,510 Printed ors Recyclable Paper
This is a summary of the SBC billing for 1111912009
Department Name Totals
CPD Garage $68.38
Fire Dept #42 $141.20
Street Dept $451.74
Water Dept $75.91
Total for the SBC Bill: $737.23
Monday, November 30, 2009 Page 1 of 1
Bill Date: 11/19/2009
Phone Number LD Charge Misc Info Line Fees Totals
CP® Garage
Location Code: AD 3400 W. 131st Street Ste. 1
733 -4600 $0.00 $0.00 $0.00 $34.189 $34.189
733 -6257 $0.00 $0.00 $0.00 $34.189 $34.189
Voice Mail: $0.00
SBC Totals: $0.00 $0.00 $0.00 $68.38 $68.38
Remit To: SBC
Bill Payment Center
Chicago, IL 60663 -0001
Monday, November 30, 2009 Page I of 5
Bill Date: 11/19/2009
Phone Number LD Charge Misc Info Line Fees Totals
Fire Dept #42
Location Code: AB 3610 W. 106th Street
733 -0545 $0.00 $0.00 $0.00 $32.313 $32.313
733 -0661 $0.00 $0.00 $0.00 $32.313 $32.313
733 -1480 $0.00 $0.00 $0.00 $44.263 $44.263
733 -1481 $0.00 $0.00 $0.00 $32.313 $32.313
Voice Mail: $0.00
SBC Totals: $0.00 $0.00 $0.00 $141.20 $141.20
Remit To: SBC
Bill Payment Center
Chicago, IL 60663 -0001
Monday, November 30, 2009 Page 2 of 5
Bill Date: 11/19/2009
Phone Number LD Charge Misc Info Line Fees Totals
Street Dept
Location Code: AA 3400 W. 131st Street
733 -2001 $0.00 $0.00 $0.00 $48.430 $48.430
733 -2002 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2003 $0.00 $0.00 $1.79 $28.680 $30.470
733 -2004 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2005 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2006 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2007 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2008 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2009 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2011 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2012 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2013 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2014 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2062 $0.00 $0.00 $0.00 $28.680 $28.680
733 -2153 $0.00 $0.00 $0.00 $28.680 $28.680
Voice Mail: $0.00
SBC Totals: $0.00 $0.00 $1.79 $449.95 $451.74
Remit To: SBC
Bill Payment Center
Chicago, IL 60663 -0001
Monday, November 30, 2009 Page 3 of 5
Bill Date: 11/19/2009
Phone Number LD Charge Misc Info Line Fees Totals
Water Dept
Location Code: AC 3450 W. 131st Street
733 -2029 $0.00 $0.00 $0.00 $37.953 $37.953
733 -2053 $0.00 $0.00 $0.00 $37.953 $37.953
Voice Mail: $0.00
SBC Totals: $0.00 $0.00 $0.00 $75.91 $75.91
Remit To: SBC
Bill Payment Center
Chicago, IL 60663 -0001
Monday, November 30, 2009 Page 4 of 5
V NO. WARRANT NO.
ALLOWED 20
AT&T
IN SUM OF
r. O. Box 8100
Aurora, IL 60507 -8100
$�1��1.
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. I ACCT #!TITLE AMOUNT Board Members
2201 317733200111 43- 440.00 $451.74 1 hereby certify that the attached invoice(s), or
V11 (A Q 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
Monday, November 30, 2009
v
t!� ommissione r'��
Title
Street Ccrimjssloner
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribetl 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 Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/19/09 317733200111 $451.74
1 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
Clerk- Treasurer