184474 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 364033 Page 1 of 1
ONE CIVIC SQUARE DANIEL SEEMILLER
217 W CHESTNUT ST CHECK AMOUNT: $400.00
CARMEL, INDIANA 46032
NEW CARLISLE IN 46552 CHECK NUMBER: 184474
CHECK DATE: 4/1412010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 400.00 PRIZE
Carmel •Clay
Parks &Recreation CHECK REQUEST
Date: 15
Check payable to
Name: fV"'I 4'
Address: v d V, 6 0 9
City, State, Zip �1 m�w
liMaii check to payee Return check to requestor
Check Amount 0 Date Required z)) -M
Check needed for ISI: Platt-, t j ro' p A G�
Supporting documentation or receipt(s) MUST be attached.
To be paid from
PO k C
Budget account GL#
Budget Line Description C' erect,
Requested by (print): MkR U- Ir
Requested by (signature): *t L �4
Approved by (signature of Division Manager): ���C1`�.( 3(a 31 w
on this date
1 3 0 3 L13 1 Form revised 1 -21 -08
MAR 2 4 2010
BY:
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
Seemiller, Dan Terms
P.O. Box 608
New Carlisle, IN 46552
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
3113110 USATT USATT winner 400.00
Total 400.00
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
Voucher No. Warrant No.
Seemiller, Dan Allowed 20
P.O. Box 608
New Carlisle, IN 46552
In Sum of
400.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members
Dept
1096 -50 USATT 4239039 400.00 1 hereby certify that the attached invoice(s), or
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
8 -Apr 2010
Signature
400.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund