194210 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 120950 Page 1 of 1
ONE CIVIC SQUARE DOUGLAS HANEY CHECK AMOUNT: $22.99
i CARMEL, INDIANA 46032 CIO DEPT OF LAW
C/0 DEPT OF LAW CHECK NUMBER: 194210
CHECK DATE: 2/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4230200 22.99 OFFICE SUPPLIES
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form 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
Douglas C. Haney
Purchase Order No.
13828 Smokey Ridge Drive
Terms
Carmel, Indiana 46033
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1 -28 -11 Reimburse Douglas C. Haney for monies he personally $22.99
expended for Departmental office supplies per the
attached receipt a
TOTAL: Total $22.99
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.
ALLOWED 20
Douglas C. Haney IN SUM OF
13828 Smokey Ridge Drive
Carmel, Indiana 4
$22.99
ON ACCOUNT OF APPROPRIATION FOR
Department of Law
420 -30200 Office Supplies
Board Members
p INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
1180 22 99 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
20
nature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund