190780 10/13/2010 CITY OF CARMEL, INDIANA VENDOR: 120301 Page 1 of 1
f, ONE CIVIC SQUARE HAMILTON COUNTY TREASURER CHECK AMOUNT: $13,221.90
CARMEL, INDIANA 46032 'CIO HAMILTON CO AUDITOR
1 HAMILTON COUNTY SQUARE CHECK NUMBER: 190780
N013LESVILLE IN 46060
CHECK DATE: 1 011 3/2010
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 13,221.90 COUNTY COURT COSTS
PRESCRIBED BY STATE BOARD OF ACCOUNTS CITY AND TOWN FORM 217 CT (1997)
REPORT TO COUNTY AUDITOR OF COURT COSTS
COLLECTED IN CITY /TOWN COURT
To the Auditor of Hamilton County, Indiana
I, Diana L. Cordray, City Officer of the City of Carmel, Indiana, hereby certify that I have received
the following amounts of the court costs payable to the County:
For the month ending June 30, 2010.
ITEMIZATION COLLECTIONS PRIOR YEAR TO DATE
THIS PERIOD COLLECTIONS
COURT COSTS: 13,221.90 101,100.20 114,322.10
TOTAL AMOUNT COLLECTED
1.3,221.90 101,100.20 114,322.10
Dated C l 2010,
1 tA
City Fiscal Officer
NOTE Mail To:
Hamilton County Auditor
One Hamilton County Square
Noblesville, IN 46060
(Make check payable to Hamilton County Treasurer)
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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.
[l Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
0
Total
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.
r ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
0
Board Members
INVOICE NO ACCT #/TITLE AMOUNT
D EP T I hereby certify that the attached invoice(s), or
(�Z4 .9 t) 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
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund