189573 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: T358705 Page 1 of 1
ONE CIVIC SQUARE ELIZABETH BURUCHIAN CHECK AMOUNT: $47.00
CARMEL, INDIANA 46032 12296 CHARING CROSS ROAD
CARMEL IN 46033 CHECK NUMBER: 189573
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
109 5023990 47.00 REISSUE CK 142139
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
�2 Q Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
AJ LL
4
t
Total
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.
ALLOWED 20
IN SUM OF
ov
ON ACCOUNT OF APPROPRIATION FOR
mq (MOAL
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
materials or services itemized thereon for
which charge is made were ordered and
received except
s y y, 20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund