160835 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 079250 Page 1 of 1
ONE CIVIC SQUARE JAY DORMAN
CARMEL, INDIANA 46032
13506 BELFORD COURT CHECK AMOUNT: $375.00
CARMEL IN 46032 CHECK NUMBER: 160835
CHECK DATE: 6/2512008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4343004 375.00 TRAVEL PER DIEMS
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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
Jay Dorman Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
A r t 5 23• m 20; June 17
375.
Total $375.00
1 hereby certify that the attached invoice(s), or biil(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
,Tay Dorman IN SUM OF
13506 Belford Cour
Carmel IN 46032
375
ON ACCOUNT OF APPROPRIATION FOR
Trafel Per Diem #430 -04
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1192 430-04 1375.0
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
a3
Li, e 20 0 8
n,
i ature
C�
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund