191666 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 362449 Page 1 of 1
Q ONE CIVIC SQUARE JUDITH HAGAN
s• 51,E CARMEL, INDIANA 46032 10946 SPRING MILL LANE CHECK AMOUNT: $100.00
'tiy oN o` CARMEL IN 46032 CHECK NUMBER: 191666
CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4341999 100.00 OTHER PROFESSIONAL FE
Carmelo Clay
Parks &Recreation CHECK REQUEST
Date: November 1 2010
N OT 12010
BY 1I
Check payable to
Name: Judith Hagan CCPR BOARD MEMBER
Address: 10946 Spring Mill Lane
City, State, Zip Carmel, IN 46032
K Mail check to payee Return check to requestor
Check Amount 100.00 Date Required ASAP
Check needed for Monthly pay for meetings attended 10/12/10,10126/10
2 Meeting(s) na $50.00 each 100.00 October 2010
To be paid from
PO (if applicable) NIA
Budget account GL 101 1125- 4341999
Budget Line Description Other Professional Fees
Invoice(s) and Purchase Order (if required) MUST be attached.
Requested by (print): Paula Schlemmer
Requested by (signature):
Approved by (signature of Division Manager). r,
on this date
Form revised 7 -7 -08 Shared Administrative Forms Staff forms Check Request (rev 7 -7 -08)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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 Purchase Order No.
362449 Hagan, Judith Terms
10946 Spring Mill Lane
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1111110 Oct'10 Park Board meeting attendance 100.00
Total 100.00
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.
362449 Hagan, Judith Allowed 20
10946 Spring Mill Lane
Carmel, IN 46032
In Sum of
100.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept
1125 Oct' 10 4341999 100.00 1 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
4 -Nov 2010
Signature
100.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund