187560 07/08/2010 CITY OF CARMEL, INDIANA VENDOR: 362339 Page 1 of 1
ONE CIVIC SQUARE CITIZENS MANAGEMENT INC CHECK AMOUNT: $3,254.57
,?o CARMEL, INDIANA 46032 HO 6 2
oN 48844 -0620 CHECK NUMBER: 187560
CHECK DATE: 7/8/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 SWC0000385 3,254.57 OTHER EXPENSES
Citizens
t ,anagemeru lnc LOSS Funk Invoice
a'I....y „,rojn,t rr,,,,,,,,, rn „nuncrrnn,p Citizens Management Inc., I M Box 620, Howell, MI 48844 -0620
TO:
MS. SHELLY M. LINGELBAUGH
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL, IN 46032
DATE: 06/30/2010
LOSS FUND INVOICE
REFERENCE AMOUNT DUE
SWC0000385
a
INITIAL DEPOSIT $25,000.00
06/30/2010 BALANCE $21,745.43
AMOUNT DUE $3,254.57
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
C M a n agemen t, Inc. Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
06130110 SWC0000385 Loss Fund invoice 3 254.57
Total $3,254.57
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER N WARRANT NO.
ALLOWED 20
,Citizens Management, Inc.
IN SUM OF$
PO Box 620
Howell, MI 48844 -0620
$3,254.57
ON ACCOUNT OF APPROPRIATION FOR
3 01 Medical Fund
Board Members
PO# or D PT INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
SWC0000385 301 $3,254.57 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund