164632 10/16/2008 CITY OF CARMEL, INDIANA VENDOR: 362003 Page 1 of 1
0 ONE CIVIC SQUARE JEFFREY CAPSHAW
CARMEL, INDIANA 46032 323 THORNBERRY DRIVE CHECK AMOUNT: $S.00
CARMEL IN 46032
CHECK NUMBER: 164632
CHECK DATE: 10/16/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4357004 5.00 EXTERNAL INSTRUCT FEE
9:1? t;Jq ?RGh: FeK 11a,niItp1i C,_auiiCy Ch 7G: :3, c 7 1 -2C15 T GE: 002 OF Opt
Hamilton County Health Department
H3 inlilton C'ountV Health Depwtnlent Phone:317- 776 -8500
COne Ham] lion Cwnty Square, S6ie 30 I"ax: 317 776 -8506
Noblesville, llntimi i 46060
INVOICE
Date of Course 9/24/2008
Course Name Cost Per Student Total Students Total
TB C ard $5.0 3 T
1, FPA 1: D.
Hamilton County Health .0ept:
Subtota $15.00
One Hamilton Co Sq. Suite 30
Noblesville, IN 46060 Ta x 0
(317) 776 85010. Balance Due $O.QO
Please make check payable to.
American Lung Association
Please send payment to:
Hamilton County Health Department
One 'Hamilton County Sq, Suite 30
Noblesville, In 46060
VOUCHF-R NO. WARRANT NO.
ALLOWED 20
Jeff C;apshaw
IN SUM OF
$5.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 43- 570.04 $5.00 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
OCT 13 2008
7
Title
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))
Reimburse Regis. Fee $5.00
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
Clerk- Treasurer