HomeMy WebLinkAbout157760 03/25/2008 CITY OF CARMEL, INDIANA VENDOR: 357804 Page 1 of 1
ONE CIVIC SQUARE COLLEEN BRODERICK CHECK AMOUNT: $4,411.26
CARMEL, INDIANA 46032 1969 PATTON DRIVE
o SPEEDWAY IN 46224 CHECK NUMBER: 157760
CHECK DATE: 3/25/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4122000 4,411.26 CITY'S SHARE OF H -INS
1
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Carm 0 clay
Parks &Recreation CHECK REQUEST
Date: 3 1 O
Check payable to
0
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Name:
Address:
City, State, Zip e ed6y
Mail check to a ee Return check to re uestor
P Y q
Check Amount �,o Date Required Ax? &H
Check needed for rr'>M S e. of vii S p ljl&i all-j r7.
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su}r -)rting documentation or receipt(s) MUST be attached.
r3ack Up o�pCU� fivy� >�Pr»�p� 1)
To be paid from
PO
Budget account GL oZ�7 O O d
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Budget Line Description �e h S'1/r 0 h C
Requested by (print):
Requested by (signature):
Approved by (signature of Division Manager):
on this date 3b q dg
Form revised 1 -21 -08
Prescribed bl State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
r
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whorri 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))
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.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
a000 a 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 C> d�
Si t re
5i
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund