185198 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 362339 Page 1 of 1
ONE CIVIC SQUARE CITIZENS MANAGEMENT INC
CARMEL, INDIANA 46032 PO Box 620
CHECK AMOUNT: $5,444.84
HOWELL MI 48844 -0620
CHECK NUMBER: 185198
CHECK DATE: 5111/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 SWC0000385 5,444.84 OTHER EXPENSES
Citizens
Manageiiient tne..
n r p ,,,y,y'MeIla r „eu,11,r m „p Citizens Management Inc., I PO Box 626, Howell, MI 48844 -0620 LOSS Fund Invoice
D
MAY 0 6 2010
TO:
MS. SHELLY M. LINGELBAUGH
CITY OF CARMEL BY
ONE CIVIC SQUARE
CARMEL, IN 46032
DATE: 04/30/2010
L OSS F INVOICE
REFERENCE R AMOUNT° DUE
SWC0000385_
INITIAL DEPOSIT $25,000.00
04/30/2010 BALANCE $19,555.16
AMOUNT DUE $5,444.84
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
BAS
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
05/06/10 SWC0000385 Loss Fund Invoice
Total $5,444.84
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 NOpg_WARRANT NO.
ALLOWED 20
Citizens Management, Inc. IN SU of
PO 'Box 620
Howell, MI 48844 -0620
s $5.444.84
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Fund
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
SWC0000385 301 $5 ,444.84 materials or services itemized thereon for
which charge is made were ordered and
received except
i
20
N rlatu f re
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund