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182171 02/09/2010 CITY OF CARMEL, INDIANA VENDOR: 362339 Page 1 of 1 0 ONE CIVIC SQUARE CITIZENS MANAGEMENT INC t �,�o CARMEL, INDIANA 46032 Po Box szo CHECK AMOUNT: $3,793.31 3.; HOWELL MI 48844 -0620 CHECK NUMBER: 182171 CHECK DATE: 2/9/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 302 5023990 SWC0000385 3,793.31 OTHER EXPENSES 1Citizens Management Inc Fund r+�,•ti,� er o���,������ cm��r Citizens Management Inc., 1 PO Box 620, Howell, MI 48844 -0620 Loss Fund Invoice TO: MS. SHELLY M. LINGELBAUGH CITY OF CARMEL ONE CIVIC SQUARE CARMEL, IN 46032 DATE: 01/29/2010 LOSS FUND INVOICE REFERENCE \MOUNT zDUE SWC0000385� INITIAL DEPOSIT $25,000.00 01/29/2010. BALANCE $21,206.69 AMOUNT DUE $3,793.31 IF YOU HAVE ANY QUESTIONS REGARDING THIS BILL PLEASE CONTACT US AT: 517 -540 -3186 PLEASE NOTE: WE ARE FORBIDDEN BY LAW TO ISSUE CHECKS SHOULD YOUR LOSS FUND BECOME ZERO BALANCE 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 Citizen's Management, Inc. Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 02/04/10 SWC0000385 Loss Fund Invoice $3,793.31 Total $3,793.31 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 NO02/04110 WARRANT NO, ALLOWED 20 Citizen's Management, Inc. IN SUM OF PO Box 620 Howell, MI 48844 -0620 $3,793.31 ON ACCOUNT OF APPROPRIATION FOR 301 Medical Claims Board Members E or INVOICE NO. ACCT #!TITLE AMOUNT hereby certify invoice( s), DEPT. hereb certif that the attached invoices or bill(s) is (are) true and correct and that the SWC0000385 301 $3,793.31 materials or services itemized thereon for which charge is made were ordered and received except Oa 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund