192483 12/07/2010 CITY OF CARMEL, INDIANA VENDOR: 359217 Page 1 of 1
ONE CIVIC SQUARE MINA KEOHANE CHECK AMOUNT: $320.00
CARMEL, INDIANA 46032 9520 BENCHMARK DRIVE, APT H
ti,�. INDIANAPOLIS fN 46240 CHECK NUMBER: 192483
CHECK DATE: 121712010
DEPARTMENT ACCOUNT PO NUMBER INVOICE N UMBER AMOUNT DESCRIPTION
1081 4340800 1625 320.00 ADULT CONTRACTORS
Carmel f- Clay
Parks &Recreattoh CHECK REQUEST
Date: ]i I I s j
Check payable to
Name: i n C;%
Address:
City, State, Zip I G T- C_ a a
Mail check to payee Return check to requestor
Check Amount Date Required aQ
Check needed for
To be paid from
PO (if applicable) r 0
Budget account GL "q
Budget Line Description ma x\ c) 4 r C
t J
Supporting documentation or receipt(s) MUST be attached
P� NOV 1 7 2010
Requested by (print): (1 BY:
Requested by (signature):
Approved by (signature of Division Manager):
on this date
Form revised 1 -21 -08
INVOICE #1625 L D escdPticm U�1
P�
Please make check payable to P.O. C1 q Y G
Mina Keohane
634 Northview Ave l) sar nat
e q- Indianapolis, IN 46220 Purchaser Dat fl
Approval
Holiday Music Program x 2 $160.00 each
Program Date: Dec. 20 2010
Program Location: Carmel Clay Parks Recreation
0 �RV, N!,TE
NOV 1. 7 2010
BY:
TOTAL: $320.00
T
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.
Keohane, Mina Terms
634 Northview Ave
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
11/17/10 1625 Holiday program 12/20/10 320.00
Total 320.00
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,
Keohane, Mina Allowed 20
634 Northview Ave
Indianapolis, IN 46220
In Sum of
320.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. 4,CCT #/TITLE AMOUNT Board Members
Dept
1081 -99 1625 4340800 320.00 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
18 -Nov 2010
Signature
320.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund