167312 12/23/2008 CITY OF CARMEL, INDIANA VENDOR: 079250 Page 1 of 1
'ONE CIVIC SQUARE JAY DORMAN
CHECK AMOUNT: $525.00
13506 BELFORD COURT
CARMEL IN 46032
CARMEL, INDIANA 46032 CHECK NUMBER: 167312
CHECK DATE: 12/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4343004 525.00 TRAVEL PER DIEMS
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
Jay Dorman Purchase Order No.
r 13506 Belford Court Terms
Carmel IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Oct 14 21 28 B Nov 12, 18; Dec 02, 16
7 mtgs.? $75. $525.00
Total $525.00
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
Jay Dorman IN SUM OF
13506 Belford Court
r
Carmel IN 45032
5.00
ON ACCOUNT OF APPROPRIATION FOR
Travel Per leiems 9430 -04
Board Members
Po #or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT I hereby certify that the attached invoice(s), or
1 4 in-o4 $525. 0 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
December 19, 2Q08_ ,20
A
Jgignature
Miehael ie
oc,
Cost distribution ledger classification if
claim paid motor vehicle highway fund