166469 12/02/2008 CITY OF CARMEL, INDIANA VENDOR: 359506 Page 1 of 1
ONE CIVIC SQUARE V G M FINANCIAL SERVICES
0 CARMEL, INDIANA 46032 CHECK AMOUNT: $420.35
z, P 0 BOX 78523
MILWAUKEE WI 53278 -0523 CHECK NUMBER: 166469
CHECK DATE: 12/2/2008
G- PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1150 4350900 LATE FEES 420.35 LATE FEES
i
I
42707/001 1 l8 619 0000018524
1111 West San Marnan Drive
Waterloo, IA 50701 INVOICE
I 800 643 -4354 (phone)
C finaancial ervices 319 833 4577 (fax)
money" „Invoice No- �Inv'oice Date Page No
1298820 11/13/2008 1
0000018524 AUTO MIXED AADC 350 For customer service contact: 800 643 -4354
Please call customer service with any address
Attn: PAUL BLOCKOMS changes or questions about your invoice.
BROOKSHIRE FIRST MORTGAGE LLC
12120 BROOKSHIRE PARKWAY
CARMEL, IN 46033 -3314
4 Customer Invoice T` Due
i
.k Account Number „Invoice Date Number 4`1V Date``
4009604 11/13/2008 1298820 15th of Month
Current Past Due Past Due, Past Due Totai
Contract No t Invoice,Description� Char es....1 =30.Da s 31..60Da s Due ._.x a
004- 4009604 001 "KE Nt�Y- MU�LI't 01250
Late Charges 0.00 79.07 79.07 262.21 420.35
Total $0.00 $79.07 $79.07 $262.21 $420.35
Prescrib4ty 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
Z
hom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
V&1 Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total i is
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
SAJ IN SUM OF
J,c�Aza toO zi4 ?D l
5'
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I 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
20
Signature
A r >F db
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund