192665 12/10/2010 CITY OF CARMEL, INDIANA VENDOR: 363779 Page 1 of 1
ONE CIVIC SQUARE JOSHUA ALBERT KIRSH
CARMEL, INDIANA 46032 2202ND AVE NE CHECK AMOUNT: $200.00
CARMEL IA 46032
CHECK NUMBER: 192665
CHECK DATE: 12/1012010
DE PARTMENT A PO N U M BER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4341999 200.00 OTHER PROFESSIONAL FE
Carmel 9 Clay
Parks &Recreation CHECK REQUEST
Date: December 1 2010
Check payable to
Name: ,Joshua Kirsh CCPR BOARD MEMBER
Address: 2202 nd Ave. NE
City, State, Zip Carmel IN 46032
X Mail check to payee Return check to requestor
Check Amount 200.00 Date Required ASAP
Check needed for Monthly pay for meetings attended 11/4/10,11/9/10,11/15/10,11/23/10
4 Meetin s 50.00 each 200.00 November 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):
on this date c?
dOR022010
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.
363779 Kirsh, Joshua Terms
220 2nd Ave., NE
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1211110 Nov'10 Park Board meeting attendance 200.00
Total 200..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 T
Clerk- Treasurer
Voucher No. Warrant No.
363779 Kirsh, Joshua Allowed 20
220 2nd Ave., NE
Carmel, IN 46032
In Sum of
200.00
�I
ON ACCOUNT OF APPROPRIATION FOR
101 General e al Fund
PO# or INVOICE NO. ACCT#rFITLE AMOUNT Board Members
Dept
1125 Nov'10 4341999 200.00 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
9 -Dec 2010
L
Signature
200.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund