191862 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 00350366 Page 1 of 1
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CARMEL, INDIANA 46032 641 WESTFIELD RD CHECK AMOUNT: $112.00
NOBLESVILLE IN 46060 CHECK NUMBER: 191862
CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
1701 4355300 112.00 ORGANIZATION MEMBER
BILLING STATEMENT
The Times
641 Westfield Road
Noblesville, IN 46060
October 28, 2010
1
C C �1 at ���a st)rLe
1 Civic Square
Carmel, In 46032
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317 -770 -7777
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
V U Terms
Q. S Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF$
WO -hdcl a
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), o r
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
A _10 6
r"
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund