181917 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 363875 Page 1 of 1
ONE CIVIC SQUARE GRANT GRAY
CARMEL, INDIANA 46032 223 HALDALE DRIVE CHECK AMOUNT: $4,039.00
CARMEL IN 46032 CHECK NUMBER: 181917
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CHECK DATE: 2/3 /2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 4,039.00 DRIVEWAY REIMBURSEMEN
Vince Gerth Contractor
262 Ha!dale Dr.
Carmel, IN 46032
Receipt of Services
Date: 11/14/09
Tear out and replace 577 sq. ft. of concrete and asphalt and replace with all
concrete. Total cost: $4,039.00.
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20- 7408.2740
GRANT GRAY 1 r2Snie. CAPCIt 713 8
LISA K. GRAY r
223 HALDALE DR. d 200 5
CARMEL, IN 4603
PAY to 1 $3,, o2
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Date :11 /16/2009 Account:40011491099 Serial:7138 Amount:$3,422.86 Sequence:92165:L0 Route &Transit:274074040 TranCoue:7138
CUIP:274.074040 Dream:N CLAMT:O
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20- 7404-2740
GRANT GRAY la 7134
USA K. GRAY
223 HALDALE DR. ii ---j I 200 et
CARMEL, IN 46032
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Date:11/13/2009 Account:40011491099 Seria1:7134 Amount:$2,500.00 Sequence:9379804 RoutekTransit:274074040 TranCode:7134
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VOUCHER 094176 WARRANT ALLOWED
T GRAY IN SUM OF
GRANT GRAY l
223 HALDALE DR
CARMEL, IN 46032 C
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
"lik7‘f Board members
PO INV ACCT AMOUNT Audit Trail Code
6 360
223 01- 6298 -06 $4,039.00
Voucher Total $4,039.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T GRAY
GRANT GRAY Purchase Order No.
223 HALDALE DR Terms
CARMEL, IN 46032 Due Date 12/30/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12!3012011 223 $4,039.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance with IC X5 5- 11- 10 -1.6_s-
f,
Date Officer