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193608 01/19/2011 A f CITY OF CARMEL, INDIANA VENDOR: 061152 Page 1 of 1 e ONE CIVIC SQUARE CLAY TWP RWD CHECK AMOUNT: $1,953.35 ?a CARMEL, INDIANA 46032 PO BOX 40638 INDIANAPOLIS IN 46240 -0638 CHECK NUMBER: 193608 CHECK DATE: 1/19/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4348500 546.98 0101016210101 1091 4348500 715.30 4000400010100 1120 4348500 66.34 0376122604988 1120 4348500 68.38 2000130154000 1125 4348500 25.01 0101006272502 1125 4348500 41.46 0143006091230 1125 4348500 67.58 0341578281126 1125 4348500 13.64 0341578286817 1125 4348500 15.68 1015000014110 2201 4348500 231.30 2000240134001 601 5023990 77.78 4000500034500 601 5023990 83.90 4000500134500 The Mission of the District to provide a high quality, cost- effective sanitary sewer service to our community. CTRWD Clay Township Regional Waste District P.O. Box 40638 0 Indianapolis, IN 46240 -0638 a Customer MONON CARMEL CLAY Service Address: 1430 96TH ST E Account Number 0143006091230 Billing Date 01/06/2011 021M(1011.103 00025302011010E GAOFX101 UAYSTMT 1 oz UOM G-r-0— 199511 u1 Ill�lllhllllltn�llIt�uitllllllllnlllil p�l�inl��v Customer Message MONON CARMEL CLAY PARKS REC 1411 E. 116TH STREET CARMEL IN 46032 -7611 F Previous Balance $47.58 Period From_ 12/06/2010 Pa yments 4758 Period To: 01/0612011 Adjustments $0.00 Total Past Due $0.00 Service Description Meter Number Cons.0000 gallons) Amount Metered Comm Primary- 1 112 In Meter 60353811 1.00000 A 41.46 G 4UPf i T L, JAN 7 201 E7 Pp� Important Information, D $41.46 This month's insert is a recap of 2010 for the District, A Year of Progress. The District offers auto -debit for your bill payment options and a -bill for your montly billing statement. To sign up, visit our website at www.ctrwd.org and download the Due Date D 01/20/2011 form. Our office will be closed Monday, January 17th. RB D $41.46 MTRB @KRa 02 -1x09- 2750112/09) Retain this portion for your records o "A Hft, REMIT TO: CLAY TOWNSHIP REGIONAL WASTE DISTRICT P.O. BOX 40638 s ,CTRWD, p' INDIANAPOLIS, IN 46240 -0638 g (317) 844 -9200 �asA� Visit our website: www.ctrwd.org PAYMENTS: Please be sure to include the bottom portion of this statement with your check or money order. Do not send cash by mail. Stapling or folding the payment stub may substantially delay the processing of your payment. You may pay your sewer bill in person at our office at 10701 N. College Ave. Suite A, Indianapolis, IN. For your convenience, you may also use our drive -up drop box at this address. Customer Service: If you have additional questions concerning your bill, please visit our office at 10701 N. College Ave. Suite A, Indianapolis, IN or call (317) 844 -9200 Monday through Friday, 8:00 a.m. to 4:30 p.m. NON PENALTY PERIOD AND LATE PAYMENT CHARGES: Current charges become delinquent if not paid by the 20th of the month. If any portion of the current charges remain unpaid after the 20th of the month, a 10 percent late fee charge will be added to your account. AUTODEBIT is available for making your monthly payment. The form can be downloaded from our website. Additional Information: A- Actual meter readings E When printed after a meter reading (previous or current) indicates an estimated reading CR Credit amount B Balanced billing applies to our residential customers only. Your monthly statements will be based on your winter consumption or if you do not yet have winter consumption history, billing will be based on an average residential monthly usage of 7,000 gallons per month. Approved by State Board of Accounts for Clay Township Regional Sewer District, 2009 02 1xQ9- 2750(,209) The Mission of the District to provide a high quality, cost effective sanitary sewer service to our community, •CTRWD• Clay Township Regional Waste District P.O. Box 40638 Indianapolis, IN 46240 -0638 Customer CARMEL CLAY PARK Service Address: 2465 116TH ST W Account Number 0341578286817 Billing Date 01/06/2011 02 -1011. 103 000250220110tH GAOFX101 CLAY STMT I OZ OOM GAO FX 10000 159541 UT III "IThl Ill)°'' lll' l' llllll "I'lllllllll'l'lllllllllllllN Customer Message CARMEL CLAY PARK REC 1411 E. 116TH ST. CARMEL IN 46032 -7611 Previous Balance $11.60 Period From: 12/06/2010 Payments $11.60 Period To: 01/06/2011 Adjustments $0.00 Total Past Due $0.00 Service Description Meter Number Cons.ogoo gallons) Amount Multi Billed Tenant Units 1.5 in 9042973 2.00000 A 13.64 I L 4AN 0 Important Information D $13.64 This month's insert is a recap of 2010 for the District, A Year of Progress_ The District offers auto -debit for your bill payment options and e -bill for your montly billing statement. To sign up, visit our website at www.ctrwd.org and download the Due Date D 01/20/2011 form. Our office will be closed Monday, January 17th. Gam^ MW @M @111D $13.64 02-U09-2750(12109) Retain this portion for your records The Mission of the District to provide a high quality, cost- effective sanitary sewer service to our community. CTRWD• Clay Township Regional Waste District P.O. Box 40638 Indianapolis, IN 46240 -0638 Customer CARMEL CLAY PARK Service Address: 3100 116TH ST W Account Number 0341578281126 Billing bate 01/06/2011 U2W10 (1'103 IXID5al2D110" GAO FT I o I CLAYSTMT 1 oz 001d GAYX I(I M541 U 11 1111 "I'I�11 lull" Ill' II�IIIII 'll�l'1�'lillllll'I�11111111 Customer Message CARMEL CLAY PARK REC 1411 E. 116TH ST. CARMEL IN 46032 -7611 tify',• Previous Balance $71.66 Period From 12/06/2010 Payments $71.66 Period To: 01/06/2011 Adjustments $0.00 Total Past Due $0.00 Service Description Meter Number Cons.0000 gallons) Amount Metered Comm Primary-2 In Meter 60268700 1.00000 A 67.58 E� JAN 0 7 Zell 7- 1: n Important Information D This month's insert is a recap of 2010 for the District, A Year of Progress. The $67.58 District offers auto -debit for your bill payment options and a -bill for your montly billing statement. To sign up, visit our website at www.ctrwd.org and download the Due Date p 01/20/2011 form. Our office will be closed Monday, January 17th. D $67.58 Retain this portion for your records 02 -1x09- 2750(12/09) The Mission of the District to provide a high quality, cost effective sanitary sewer service to our community. Clay Township Regional Waste District an Hy Statement CTRWD P0. Box 40638 Indianapolis, IN 46240 -0638 AtY Customer CARMEL CLAY PARK Service Address: 1411 116TH ST E Account Number 1015000014110 Billing Date 01/06/2011 02IWIlD 11'103 MO2533201101W G-101 rLAVSTMT I OZ DO M GADFx l MOO' I59511 VT I�II'lll�'I�' 1111' lll�lll' IL�I11�11 t�1'�'� "I'I��� "I�I�I'�IIII� Customer Message CARMEL CLAY PARK REC 1411 E. 116TH ST. CARMEL IN 46032 -7611 Previous Balance $15.68 Period From: 12/06/2010 Payments $15.68 Period To: 01/06/2011 Adjustments $0.00 Total Past Due $0.00 Service Description Meter Number Con s.0000 gallons) Amount Metered Comm Primary-5/8 In Meter 35379081 3.00000 A 15.68 i J AN 0 7 201 Important Information D $15.68 This month's insert is a recap of 2010 for the District, A Year of Progress. The District offers auto -debit for your bill payment options and a -bill for your montly billing statement. To sign up, visit our website at www.ctrwd.or Due Date g and download the D 0 1/20/201 1 form. Our office will be closed Monday, January 17th. GGbOf $15.68 02 -1x0g- 2750112109 Retain This portion for your records The Mission of the District to provide a high quality, cost effective sanitary sewer service to our community. W Clay Township Regional Waste District •CTRwD- P0. Box 40638 fM nWy SWeffl�ll eM Indianapoiis, IN 46240 -0638 n AEGbNLL Customer CARMEL CLAY PARKS Service Address: 1235 CENTRAL PARK DR E Account Number 0101006272502 Billing Date 01/06/2011 (17/(#110 11;10 a 0002528 201101W GAOFX I01 ­STMT 1 OZ DOM GAOFX I WN' 159511 DT II�II�I1111iII�IIII�"' IIII111�1 "II'�I'�I'1'IIIIIILLIJ�I Customer Message CARMEL CLAY PARKS 1411 E 116TH ST CARMEL IN 46032 -7611 p�! Previous Balance $25 -01 Period From: 12/0612010 Payments $25.01 Period To: 01/06/2011 Adjustments $0.00 Total Past Due $0.00 Service Description Meter Number Cons.ogoo gallons) Amount Metere Comm Primaryy Fog 1 In Meter 0101006272 0.00000 A 25.01 f JAN 0 7 2011 F- Important Information ftm 1 D $25.01 This month's insert is a recap of 2010 for the District, A Year of Progress. The District offers auto -debit for your bill payment options and e -bill for your montly billing statement. To sign up, visit our website at www.ctrwd.org and download the Due Date D 01/20/2011 form. Our office will be closed /Monday, January 17th. D $25.01 Retain this portion for your records 02- 109- 2750(12109) The Mission of the District to provide a high quality, cost- effective sanitary sewer service to our community. Clay Township Regional Waste District f,1 cTRwc P.O. Box 40638 u�u y SWOMeM Indianapolis, IN 46240 -0638 e Customer CARMEL CLAY PARKS Service Address: 1235 CENTRAL PARK DR E Account Number 0101016210101 Billing Date 01/06/2011 021b111011 103 000 2529 20110104 GAUX101 CI.AYSTM 1 I OZ LORI GA— I- 0 -1 UT if111411htPlhl�nlnrll�llh�1�11r�l�llll�ru�rrlll Customer Message CARMEL CLAY PARKS 1411 E 116TH ST CARMEL IN 46032 -7611 "•3': Previous Balance $606.14 Period From: 12/06/2010 Payments $606.14 Period To. 01/06/2011 Adjustments $0.00 Total Past Due $0.00 Service Description Meter Number Cons.fl000 gallons) Amount Metered Comm Primary Fog 2 In Meter 60897458 236.00000 A 546.98 i L, JAN 0 T Important Information pG C fiiT f3 D $646.98 This month's insert is a recap of 2010 for the District, A Year of Progress. The District offers auto -debit for your bill payment options and e -bill for your montly billing statement. To sign up, visit our website at www.ctrwd.org and download the Due Date 01/20/2011 form. Our office will be closed Monday, January 17th. VV Awm&D MT @M $546.98 Retain this portion for your records 02 149 2750�12109) The Mission of the District to provide a high quality, cost- effective sanitary sewer service to our community. CTRwp• P.O. Box P.O. Box 40638 Indianapolis, IN 46240 -0638 REfdWLL� Customer CARMEL CLAY CENTRAL Service Address: 1235 CENTRAL PARK DR E Account Number 4000400010100 Billing Date 01/06/2011 02(04110 11 102 (10025.4420110100 GA IO I UAVSTM7102 OOM GAOFX I WOD• 154541 UT �I�I" II"' 1�1�1�' �I' �I' ll��ll' I'llll�l'1�11!'I'S'll'lll��l��l Customer Message CARMEL CLAY CENTRAL PARK 1411 E 116TH ST CARMEL IN 46032 -7611 ii Previous Balance $774.46 Period From: 12/06/2010 Payments $774 -46 Period To: 01/06/2011 Adjustments $0.00 Total Past Due $0.00 Service Description Meter Number Cons.0000 gallons) Amount Metered Comm Primary Fog 2 In Meter 59392985 93.00000 A 715.30 59392986 97.00000 60863133 0.00000 r r F i JAN 0 7 2011 IM136Mrtt•InfotmatIon........ D $715.30 This month's insert is a recap of 2010 for the District, A Year of Progress. The District offers auto -debit for your bill payment options and e -bill for your montly billing statement. To sign up, visit our website at www- ctrwd.org and download the Due Date D 01/20/2011 form- Our office will be closed Monday, January 17th. MR @M @MD D $715.30 Retain this portion for your records 02- aXo9- 2750t12v0s) 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. 061152 Clay Tvvp Regional Waste District Terms PO Box 40638 Date Due Indianapolis, IN 46240 -0638 {s) or bill(s)} Invoice Invoice Description Date Number (or note attached invoice Amount 116111 0143006091230 14 E 96th St South T railhead 41.46 116111 341578286817 2465 W. 1 16th St Storage Building 13.64 116111 341578281126 3100 W 116th St -West Park 67.58 116111 1015000014110 1411 E. 116th St. Adm. 15.68 116111 101006272502 1235 Central Park E. Dr. Monon Center 25.01 116111 101016210101 1235 Central Park E. Dr. Monon Center 546.98 116111 4000400010100 1235 Central Park E. Dr. 6 meters 715.30 7otak 1,425.63 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. 061152 Clay Twp Regional Waste District Allowed 20 PO Box 40638 Indianapolis, IN 46240 -0638 in Sum of 1,425.65 ON ACCOUNT OF APPROPRIATION FOR 101 General 109 Monon Center PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept 1125 0143006099230 4348500 41.46 1 hereby certify that the attached invoice(s), or 1125 341578286817 4348500 13.64 bill(s) is (are) true and correct and that the 1125 341578281126 4348500 67.58 materials or services itemized thereon for 1125 1015000014110 4348500 15.68 which charge is made were ordered and 1091 101006272502 4348500 25.01 received except 1091 101016210101 4348500 546.98 1091 40004000101oo 4348500 715.30 13 -Jan 2011 Signature 1,425.65 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund The Mission of the District to provide a high quality, cost o effective sanitary sewer service to our community. •CTRWD• Clay Township Regional Was District �0��� ����QMO�� P0. Box 40638 Indianapolis, IN 46240 -0638 Customer CARMEL_ ST DEPT Service Address: 3400 131ST ST W Account Number 2000240134001 Billing Date 01/06/2011 02MrIO 11.10 3 0(10)650 20110101 GAOF %102 C�AYSTMT I OZ OOM GAOF %I WOO' 159501 UT itII�IIIiIlhilih�t�ilht�lil °r�I�Ini�ul�rttildrihliii Customer Message CARMEL ST DEPT 3400 w 131sT ST CARMEL IN 46074 -8267 0 Previous Balance $239.46 Period From: 12/06/2010 Payments $239.46 Period To: 01/06/2011 Adjustments $0.00 Total Past Due $0.00 Service Description Meter N u mber Consm000 gallons) Amount Metered Comm Primary-2 In Meter 60121546 5.00000 A 231.30 60334360 9.00000 60360195 3.00000 Important Information Gtl. D $231.30 This month's insert is a recap of 2010 for the District, A Year of Progress. The District offers auto -debit for your bill payment options and e -bill for your montly Due Date billing statement. To sign up, visit our website at www.ctrwd.org and download the 0112012011 form. Our office wilt be closed Monday, January 17th. G�Cb� D $231.30 02- 1x09 2750(12109) Retain this portion for your records VOUCHER NO. WARRANT NO. ALLOWED 20 Clay Township Regional Waste District IN SUM OF P. O. Box 40638 Indianapolis, IN 46240 -0638 $231.30 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 2201 43- 485.00 $231.30 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 Thursday, January 13, 2011 Street Commissioner 11 t er t'cTtei�`��cner Cost distribution ledger classification if claim paid motor vehicle highway fund 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. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 01/06/10 $231.30 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 The Mission of the District to provide a high quality, cost 11 A4 effective sanitary sewer service to our community. CT WD. Clay Township Regional Waste District P.O. Box 40638 Indianapolis, IN 46240 -0638 AR OMS�� Customer FIRE STATION #46 Service Address: 540 136TH ST W Account Number 2000130154000 Billing Date 01/06/2011 02PMI10 11 10 3 IXfXM5 zD IM cAO—1 GTAYSTMT 1 OZ DOM CAOFMI­ 159Mi UT I�'III'll' 11111' �IIII" I�I' IIIII�I ''I�I�I'III�P'�il�l "I�I� "II Customer Message FIRE STATION #46 2 CIVIC SQUARE CARMEL IN 46032 -2584 n? Previous Balance $52.06 Period From: 12/06/2010 Payments -$52.06 Period To: 01/06/2011 Adjustments $0.00 Total Past Due $0.00 Service Description Meter Number Cons .0000 gallons) Amount Metere Comm Primaryy Fog 1 In Meter 48889163 6.00000 A 68.38 48889164 9.00000 Important Information D $68.38 This month's insert is a recap of 2010 for the District, A Year of Progress. The District offers auto -debit for your bill payment options and a -bill for your montly Due Date billing statement. To sign up, visit our website at www.ctrwd.org and download the 01/20/2011 form. Our office will be closed Monday, January 17th. GCb�Cfb $68.38 02 -txog- 2750(12109) Retain this portion for your records The Mission of the District to provide a high quality, cost- effective sanitary sewer service to our community. Clay Township Regional Waste District b •CTRWD• P.O. Box 40638 ?J Indianapolis, IN 46240 -0638 n Customer FIRE STATION #42 Service Address: 3610 106TH ST W Account Number 0376122604988 Billing Date 01/06/2011 02)O111011 ](13 00002+¢ 2O1 101N1 GAOFXIOI CLAYS TMT I OZ UOM GAOFX I- 155511 UT 11111111111111 l'" "'�111IIIIII1Jill Customer Message FIRE STATION #42 2 CIVIC SQUARE CARMEL IN 46032 -2584 h rte% Previous Balance $66.34 Period From: 12/06/2010 Pavments $66.34 Period To: 01/06/2011 Adjustments $0.00 Total Past Due $0.00 Service Description Meter Number Cons. 0000 aalhons) Amount Metered Comm Mich Rd Fog 1 In Meter 10856168 7.00000 A 66.34 10856207 7.00000 Important Information D $66.34 This month's insert is a recap of 2010 for the District, A Year of Progress. The District offers auto -debit for your bill payment options and e -bill for your montly billing statement. To sign up, visit our website at www.ctrwd.org and download the Due Date p 01120/2011 form. Our office will be closed Monday, January 17th. AWSMIBM aLiT $66.34 02 -1x09- 2750112109) Retain this portion for your records VOUCHER NO. WARRANT NO. ALLOWED 20 Clay Twp. RWD IN SUM OF P.O. Box 40638 Indianapolis, IN 46240 $134.72 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# I Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members 1120 2000130154000 43- 485.00 $68.38 1 hereby certify that the attached invoice(s) or 1120 0376122604988 43 $66.34 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 JAN 1 70f� 1 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1996) 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. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 2000130154000 46 $68.38 0376122604988 42 $66.34 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 The Mission of the District to provide a high quality, cost effective sanitary sewer service to our community. cTRwo Clay Township Regional Waste District P.O. Box 40638 Indianapolis, IN 46240 -0638 a AHJM1y Customer CARMEL WATER Service Address: 3450 131 ST ST W #B Account Number 4000500134500 Billing Date 01/06/2011 O2tt 1011103 0 M422f11 tOtfJS GAOF %102 CLAY -T I OZ DOM GAOF%IWW' 15951 D1 Customer Message CARMEL WATER FACILITY 3450 w 131 STREET #B CARMEL IN 46074 -8267 Previous Balance $94.58 Pe From: 12/06/2010 Payments $87 -98 Period To: 01/06/2011 Adjustments $0.00 Total Past Due $6.60 Service Description Meter Number Cons.opoo gallons) Amount Metered Comm Michigan Rd -2 In Meter 60491814 9.00000 A 83.90 Important Information D $90.50 This month's insert is a recap of 2010 for the District, A Year of Progress. The District offers auto -debit for your bill payment options and a -bill for your montly Date billing statement. To sign up, visit our website at www.ctrwd.org and download the Due p 0112012011 form.. Our office will be closed Monday, January 17th. MT91D @n $90.50 02 -1x09- 2750(12/09) Retain this portion for your records The Mission of the District to provide a high quality, cost- effective sanitary sewer service to our community. Clay Township Regional Waste District cTRwo P.O. Box 40638 monmy Statement Indianapolis, IN 46240 -0638 e n ncaaleiv Customer CARMEL WATER Service Address: 3450 131ST ST W #A Account Number 4000500034500 Billing Date 01/0612011 021WI10 S1 to g M00 51 20110 —UAOF 102 CLAVSTMT l DZ UOM GAOFx1O0W 15 13 UT I�I� Customer Message CARMEL WATER FACILITY 3450 w 131 STREET #A CARMEL IN 46074 -8267 Previous Balance $100.44 Period From: 12/06/2010 Payments Period To: 01/06/2011 Adjustments $0.00 Total Past Due $16.54 Service Description Meter Number Cons.m000 gallons) Amount Metered Comm Michigan Rd -2 In Meter 60491813 6.00000 A 77.78 q �l Important Information D $94.32 This month's insert is a recap of 2010 for the District, A Year of Progress. The District offers auto -debit for your bill payment options and a -bill for your montly Due Data billing statement. To sign up, visit our website at www.ctrwd.org and download the 0112012011 form. Our office will be closed Monday, January 17th. 1. D $94.32 Retain this portion for your records 02- 1x09 2750 (12/09) VOUCHER 103753 WARRANT ALLOWED 061152 IN SUM OF CLAY TOWNSHIP REGIONAL WASTE- PO BOX 40638 INDIANAPOLIS, IN 46240- 06380P� Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 40005001345 01- 6360 -06 $83.90 Voucher Total $8� Cost distribution ledger classification if claim paid under vehicle highway fund 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 of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 061152 CLAY TOWNSHIP REGIONAL WASTE -40638 Purchase Order No. PO BOX 40638 Terms INDIANAPOLIS, IN 46240 -0638 Due Date 12/30/2010 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/30/201( 4000500134' $83.90 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 J �R„r�. t^-. 'i ^'cam- -it Date Officer