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189738 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 364685 Page 1 of 1 ONE CIVIC SQUARE CHARITY COLTER CARMEL, INDIANA 46032 210 1ST AVE NE CHECK AMOUNT: $100.00 CARMEL IN 46032 CHECK NUMBER: 189738 CHECK DATE: 9/14/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 100.00 GAZEBO REFUND r� Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER Oty Form No, 201 (Rev. 1995) CITY OF CARMEL An invoice or bill to be properly itemized must showy 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 Q f Purchase Order No. Rio F Terms 4 Date Due Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount r ©r r �un r� •�-r b-� Total f r' 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 NO. WARRANT NO. ALLOWED 20 IN SUM OF a o i s A v A/ E- ON ACCOUNT OF APPR PRIATION FOR Board Members PD# or DEPT. r INVOICE NO. ACCT #/TITLE AMOUNT 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 f� 2« Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund