191794 11/10/2010 *f CITY OF CARMEL, INDIANA VENDOR: 358941 Page 1 of 1
0 ONE CIVIC SQUARE PETTY CASH BROOKSHIRE GOLF CO CK AMOUNT: $82.09
CARMEL, INDIANA 46032
C/0 PAM LISTER
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CHECK NUMBER: 191794
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CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION
1207 4239040 11.59 FOOD BEVERAGES
1207 4239099 70.50 OTHER MISCELLANOUS
Prescribed by State Board ot 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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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.
II
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
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Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. !hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
Q 1 2 6 1 0 q 1 SO materials or services itemized thereon for
which charge is made were ordered and
received except
5/ 7 20 i>
/,7 -1/
Si ature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund