192827 12/15/2010 CITY OF CARMEL, INDIANA VENDOR: 120301 Page 1 of 1
ONE CIVIC SQUARE HAMILTON COUNTY TREASURER CHECK AMOUNT: $12,265.90
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CARMEL, INDIANA 46032
s,,�•+c C!0 HAMILTON CO AUDITOR
o 1 HAMILTON COUNTY SQUARE CHECK NUMBER: 192827
NOBLESVILLE IN 46060
CHECK DATE: 12115/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 12,265.90 COUNTY COURT COSTS
PRESCRIBED BY STATE BOARD OF ACCOUNTS CITY AND TOWN FORM 217 CT (1997)
REPORT TO COUNTY AUDITOR OF COURT COSTS
COLLECTED IN CITY/TOWN COURT
r To the Auditor of Hamilton County, Indiana
I, Diana L. Cordray, City Officer of the City of Carmel, Indiana, hereby certify that I have received
the following amounts of the court costs payable to the County:
For the month ending �WW!Abo 30, 2010.
ITEMIZATION COLLECTIONS PRIOR YEAR TO DATE
THIS :PERIOD COLLECTIONS
COURT COSTS: 12,265.90 127,344.00 136,609.90
I
TOTAL AMOUNT COLLECTED
12,265.90 127,344.00 139,609.90
Dated 2010.
CQ
City Fiscal Officer
NOTE Mail To:
Hamilton. County Auditor
One Hamilton County Square
Noblesville, IN 46060
(Make check payable to Hamilton County Treasurer)
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Farm 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
C (0AlU V Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
'Ous ,C, U
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.
-�t)4 ALLOWED 20
IN SUMO
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT, I 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
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Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund