155576 01/16/2008 CITY OF CARMEL, INDIANA VENDOR: 060000 Page 1 of 1
ONE CIVIC SQUARE CARMEL UTILITIES
CARMEL, INDIANA 46032 WATER a SEWER UTILITIES CHECK AMOUNT: $108.32
CARMEL IN 46032 CHECK NUMBER: 155576
CHECK DATE: 111612008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 R4348500 14.87 0372406400
2201 R4348500 29.74 0522323700
2201 R4348500- 44.61 0572324000
2201 R4348500 10.00 1822424000
2201 R4348500 9.10 3501234002:
CITY OF CARMEL KEEP THIS PORTION 1 YOUR RECORDS
CARMEL UTILITIES CUSTOMER SERVICES
WATER WASTEWATER UTILITIES Po BOX 1 09 (31 571 -2442
CARMEL, IN 46082 -0109 MONDAY FRIDAY
A"'ROVFD 13Y STATE BpARD OF ACCOUNTS 1:9R CITY OF CARMEI. 2fAR 8: FOAM 5:00 PM
SERVICE PERIOD METER READINGS UNITS AMOUNT
FROM =TO PREVIOUS PRESENT BILLED
WATER 0 14.87
__.M E-rEtE'
n,000-
57.000-
N
rn
37.000-
D
17.000--
i
i p J F M A M J J A S 0 N D
SERVICE ADDRESS:
AMOUNT DUE
BILLING DATE PAST D ER AFTER U TE ACCOUN UM R AMO N E
PAYMENTS: Payments are due at the Carmel Utilities office on the due date printed on the bill. Be sure to write your account number on
checks or money orders. Carmel Utilities charges a $20 fee for checks returned for nonpayment. Customers can pay in the following ways:
Mail the payment and return stub in the envelope provided to the
Carmel Utilities office. Allow sufficient postal delivery time as your Bu kiln
account will be assessed penalties if it is not received in our offices by 760 3rd
the due date. 3rd Ave. sw Ave. sw A
Bring your payment and return stub to the Carmel Utilities offices at
760 3rd Avenue S.W. during normal business hours.
Drop your enveloped payment and return stub in one of our payment 4
drop boxes. (See map) quaae T
Sign up for bank drafting. We will send your usual billing each month
with a notation "BANK DRAFT ON DUE DATE No more check parking lat
writing and it's always on time! drnp b- Range Line Rd. North
RATES:
MINIMUM CHARGE The basis of this charge is the size of the meter serving the property location.
CURRENT USAGE The amount of water consumed in a billing period.
SUMMER SEWER RELIEF (Residential Property) The customer is billed for sewer usage in the months of May through October based
on the average usage for the previous months November through April. This is to adjust for the volume of water measured through the
water meter but used on lawns and other areas external to the service address and not passing through the sewer lines to be pr ocessed.
NEW CUSTOMER FEE There is a one -time service fee for new accounts of $20. The water meter will be read on the beginning service
date and each month thereafter.
ESTIMATES Occasionally bills must be estimated when a meter is inaccessible usually due to extreme weather conditions. Carmel
Utilities estimates bills only when unable to obtain readings. If plantings or structures of any kind block access to the meter pit, the
readings may be estimated until the obstruction is removed.
DELINQUENT NOTICE: A delinquent notice will be sent to any account with an outstanding balance over 45 days. This notice is a final
reminder prior to termination of service. Should you receive such a notice be sure to contact our offices immediately to verify our records if
you have made payment. If payment is not received by the due date on this notice, your water service will be terminated and you will be
charged a service fee. Ask to speak with our Delinquent Account Representative if you need assistance in resolving this debt.
HIGH USAGE: Leaks or malfunctions in toilets, water softeners, faucets, ice makers, humidifiers, and lawn sprinklers cause high usage. To
test for leaks, read your meter before going to bed and again in the morning before using any water. If the meter's reading has changed and
no water was knowingly used, a problem may exist. Toilets are most often the cause. Check to see if water is running into the tank overflow;
if it is, there is a problem. If not, add food color to the tank and check the bowl an hour later. If the dye has seeped into the bowl or is not
visible in the tank, a leak exists. If the problem continues, or you cannot find the leak, consult a qualified person to make the necessary
repairs. Carmel Utilities is not responsible for service lines from the water meter to the service address.
Meter Pit/Service Lines: Residential customers
The property owner owns the meter pit and service lines to the residence. Carmel Water Utilities is responsible for water service lines from
the water main to the meter pit. The meter pit, lid, and casting are the homeowner's responsibility. All plumbing from the meter pit to the
home is the responsibility of the homeowner, including any house side valves and meter yoke. All repairs to the house side plumbing and
any associated costs are the homeowner's responsibility. If there is a curb stop all plumbing past the curb stop is the responsibility of the
homeowner. All repairs and associated costs after the curb stop are the homeowner's responsibilty. Carmel Utilities maintains ownership of
the meter and any radio equipment.
From time to time you may receive notice from us of a need to provide a service repair to the meter pit. Usually this is a request to keep
grass or any other matter from covering or interfering with the meter pit lid or a request to replace damaged parts. Your response within 30
days of the date of the notice is needed in order to have accurate readings of your water meter. At no time should planting or structure be
placed on the meter pit.
CITY OF CAR KEEP THIS PORTION FOR YOUR RECORDS
CARMEL UTILITIES CUSTOMER SERVICES
WATER- WAST UTILITIES PO BOX 109 (317) 571 -2442
CARMEL, IN 46082 -0109 MONDAY FRIDAY
AP,iROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 2002 8:00AM 5:00 PM
SERVICE PERIOD METER READINGS UNITS AMOUNT
FROM TO PREVIOUS PRESENT BILLED
11/21/07 12/21/07 879 879
WATER 0 10.0
M ETEREID
330,001
230,000- -s
a�
m
30,000-
D J F M A M J J A S O N D
SERVICE ADDRESS: 116TH /MCKENZIE /IRR
AMOUNT DUE
BILLING DATE PAST DUE AFTER AFTER DUE DATE ACCOUNT NUMBER AMOUNT DUE
01/05/08 01/23/08 $10.00 1822424000 $10.00
PAYMENTS: Payments are due at the Carmel Utilities office on the due date printed on the bill. Be sure to write your account number on
checks or money orders. Carmel Utilities charges a $20 fee for checks returned for nonpayment. Customers can pay in the following ways:
Mail the payment and return stub in the envelope provided to the 4
Carmel Utilities office. Allow sufficient postal delivery time as your Utilities
account will be assessed penalties if it is not received in our offices by 760 3rd
the due date. Ave. SW
3rd Ave. SW Al
Bring your payment and return stub to the Carmel Utilities offices at
760 3rd Avenue S.W. during normal business hours.
Drop your enveloped payment and return stub in one of our payment
drop- boxes. (See map) square
Sign up for bank drafting. We will send your usual billing each month
with a notation "BANK DRAFT ON DUE DATE No more check Parking be
writing and it's always on time! Range Line Rd, North
RATES:
MINIMUM CHARGE The basis of this charge is the size of the meter serving the property location.
CURRENT USAGE The amount of water consumed in a billing period.
SUMMER SEWER RELIEF (Residential Property) The customer is billed for sewer usage in the months of May through October based
on the average usage for the previous months November through April. This is to adjust for the volume of water measured through the
water meter but used on lawns and other areas external to the service address and not passing through the sewer lines to be pr ocessed.
NEW CUSTOMER FEE There is a one -time service fee for new accounts of $20. The water meter will be read on the beginning service
date and each month thereafter.
ESTIMATES Occasionally bills must be estimated when a meter is inaccessible usually due to extreme weather conditions. Carmel
Utilities estimates bills only when unable to obtain readings. If plantings or structures of any kind block access to the meter pit, the
readings may be estimated until the obstruction is removed.
DELINQUENT NOTICE: A delinquent notice will be sent to any account with an outstanding balance over 45 days. This notice is a final
reminder prior to termination of service. Should you receive such a notice be sure to contact our offices immediately to verify our records if
you have made payment. If payment is not received by the due date on this notice, your water service will be terminated and you will be
charged a service fee. Ask to speak with our Delinquent Account Representative if you need assistance in resolving this debt.
HIGH USAGE: Leaks or malfunctions in toilets, water softeners, faucets, ice makers, humidifiers, and lawn sprinklers cause high usage. To
test for leaks, read your meter before going to bed and again in the morning before using any water. If the meter's reading has changed and
no water was knowingly used, a problem may exist. Toilets are most often the cause. Check to see if water is running into the tank overflow;
if it is, there is a problem. If not, add food color to the tank and check the bowl an hour later. If the dye has seeped into the bowl or is not
visible in the tank, a leak exists. If the problem continues, or you cannot find the leak, consult a qualified person to make the necessary
repairs. Carmel Utilities is not responsible for service lines from the water meter to the service address.
Meter Pit/Service Lines: Residential customers
The property owner owns the meter pit and service lines to the residence. Carmel Water Utilities is responsible for water service lines from
the water main to the meter pit. The meter pit, lid, and casting are the homeowner's responsibility. All plumbing from the meter pit to the
home is the responsibility of the homeowner, including any house side valves and meter yoke. All repairs to the house side plumbing and
any associated costs are the homeowner's responsibility. If there is a curb stop all plumbing past the curb stop is the responsibility of the
homeowner. All repairs and associated costs after the curb stop are the homeowner's responsibilty. Carmel Utilities maintains ownership of
the meter and any radio equipment.
From time to time you may receive notice from us of a need to provide a service repair to the meter pit. Usually this is a request to keep
grass or any other matter from covering or interfering with the meter pit lid or a request to replace damaged parts. Your response within 30
days of the date of the notice is needed in order to have accurate readings of your water meter. At no time should planting or structure be
placed on the meter pit.
CITY OF CAR KEEP THIS PORTION FOR YOUR RECORDS
CARMEL UTILITIES CUSTOMER SERVICES
�+IATER- WASTMATER UTILITIES PO BOX 109 (317) 571 -2442
CARMEL, IN 46082 -0109 MONDAY FRIDAY
APfiROVEI) 13Y STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 2002 8:OOAM 5 5 '00 PM
SERVICE PERIOD METER READINGS UNITS AMOUNT
FROM TO PREVIOUS PRESENT BILLED
11/29/07 01/04/08 752 752E
WATER 0 9.10
METERED
15,001-
i
1
J F i
M A M J J A 9 0 N 0 _'J pp
SERVICE ADDRESS: 9630 WESTFI BLVD
AMOUNT DUE
BILLING DATE PAST DUE AFTER AFTER DUE DATE ACCOUNT NUMBER AMOUNT DUE
01 10
PAYMENTS: Payments are due at the Carmel Utilities office on the due date printed on the bill. Be sure to write your account number on
checks or money orders. Carmel Utilities charges a $20 fee for checks returned for nonpayment. Customers can pay in the following ways:
Mail the payment and return stub in the envelope provided to the
Carmel Utilities office. Allow sufficient postal delivery time as your utilities 1
Bukig
account will be assessed penalties if it is not received in our offices by 7760 3rd
the due date. 3rd Ave. SW Ave. sw
Bring your payment and return stub to the Carmel Utilities offices at
760 3rd Avenue S.W. during normal business hours.
Drop your enveloped payment and return stub in one of our payment a
drop boxes. (See map) Fountain
Sign up for bank drafting. We will send your usual billing each month
with a notation "BANK DRAFT ON DUE DATE No more check Parking lot
writing and it's always on time! drop box Range Line Rd. North
RATES:
MINIMUM CHARGE The basis of this charge is the size of the meter serving the property location.
CURRENT USAGE The amount of water consumed in a billing period.
SUMMER SEWER RELIEF (Residential Property The customer is billed for sewer usage in the months of May through October based
on the average usage for the previous months November through April. This is to adjust for the volume of water measured through the
water meter but used on lawns and other areas external to the service address and not passing through the sewer lines to be pr ocessed.
NEW CUSTOMER FEE There is a one -time service fee for new accounts of $20. The water meter will be read on the beginning service
date and each month thereafter.
ESTIMATES Occasionally bills must be estimated when a meter is inaccessible usually due to extreme weather conditions. Carmel
Utilities estimates bills only when unable to obtain readings. If plantings or structures of any kind block access to the meter pit, the
readings may be estimated until the obstruction is
DELINQUENT NOTICE: A delinquent notice will be sent to any account with an outstanding balance over 45 days. This notice is a final
reminder prior to termination of service. Should you receive such a notice be sure to contact our offices immediately to verify our records if
you have made payment. If payment is not received by the due date on this notice, your water service will be terminated and you will be
charged a service fee. Ask to speak with our Delinquent Account Representative if you need assistance in resolving this debt.
HIGH USAGE: Leaks or malfunctions in toilets, water softeners, faucets, ice makers, humidifiers, and lawn sprinklers cause high usage. To
test for leaks, read your meter before going to bed and again in the morning before using any water. If the meter's reading has changed and
no water was knowingly used, a problem may exist. Toilets are most often the cause. Check to see if water is running into the tank overflow;
if it is, there is a problem. If not, add food color to the tank and check the bowl an hour later. If the dye has seeped into the bowl or is not
visible in the tank, a leak exists. If the problem continues, or you cannot find the leak, consult a qualified person to make the necessary
repairs. Carmel Utilities is not responsible for service lines from the water meter to the service address.
Meter Pit/Service Lines: Residential customers
The property owner owns the meter pit and service lines to the residence. Carmel Water Utilities is responsible for water service lines from
the water main to the meter pit. The meter pit, lid, and casting are the homeowner's responsibility. All plumbing from the meter pit to the
home is the responsibility of the homeowner, including any house side valves and meter yoke. All repairs to the house side plumbing and
any associated costs are the homeowner's responsibility. If there is a curb stop all plumbing past the curb stop is the responsibility of the
homeowner. All repairs and associated costs after the curb stop are the homeowner's responsibilty. Carmel Utilities maintains ownership of
the meter and any radio equipment.
From time to time you may receive notice from us of a need to provide a service repair to the meter pit. Usually this is a request to keep
grass or any other matter from covering or interfering with the meter pit lid or a request to replace damaged parts. Your response within 30
days of the date of the notice is needed in order to have accurate readings of your water meter. At no time should planting or structure be
placed on the meter pit.
KEEP THIS PORTION FOR YOUR RECORDS
CITY OF CAR
CARMEL UTILITIES CUSTOMER SERVICES
WATER- WASTEWATER UTILITIES PO PDX 109 (317) 571 -2442
CARMEL, IN 46082 -0109 MONDAY FRIDAY
APPROVED FY STATE EO AKD Or ACCOUN IS FOR Cl I Y OF CARNIrL 2002 8:00AM 5:00 PM
SERVICE PERIOD METER READINGS IN THOUSAND AMOUNT
FROM TO PREVIOUS I PRESENT GALLONS BILLED
11130/07 01/04/08 201 201E
WATER 0 $14.87
Total Location Charges For: BENNETTRDIOAKRDG /IRR #RDB $14.87
11/30/07 01104108 95 95E
WATER 0 $14.87
Total Location Charges For: ADIOS PAS /OAKRDGIIRR #RDB 7 $14.87
ACCOUNT NUMBER: 0522323700 CUSTOMER NAME CARMEL STREET DEPT
BILLING DATE 01/10/08 PAYMENT DUE BY 01/28/08
PREVIOUS BALANCE FOR ALL LOCATIONS $0.00
CURRENT BILLING FOR ALL LOCATIONS $29.74
TOTAL AMOUNT DUE $29.74
AMOUNT DUE AFTER 01/28/08 $29.74
PAYMENTS: Payments are due at the Carmel Utilities office on the due date printed on the bill. Be sure to write your account number on
checks or money orders. Carmel Utilities charges a $20 fee for checks returned for nonpayment. Customers can pay i%the following ways:
Mail the payment and return stub in the envelope provided to the
Carmel Utilities office. Allow sufficient postal delivery time as your
account will be assessed penalties if it is not received in our offices by —11110-
0 J riALL T
the due date. MOF BOX
Bring your payment and return stub to the Carmel Utilities offices in T FOUNTAIN
City Hall during normal business hours. (See map) SQUARE ROP H Ux AVE "v
D y
ROP z
Drop your enveloped payment and return stub in one of our payment
z PARKING LOT
drop boxes. (See map) )ROP 130x
Sign up for bank drafting. We will send your usual billing each month RANCTLINE ROAD
with a notation "BANK DRAFT ON DUE DATE No more check
writing and it's always on time!
RATES:
MINIMUM CHARGE The basis of this charge is the size of the meter serving the property location.
CURRENT USAGE The amount of water consumed in a billing period.
SUMMER SEWER RELIEF (Residential Property) The customer is billed for sewer usage in the months of May through October based
on the average usage for the previous months November through April. This is to adjust for the volume of water measured through the
water meter but used on lawns and other areas external to the service address and not passing through the sewer lines to be processed.
NEW CUSTOMER FEE There is a one -time service fee for new accounts of $20. The water meter will be read on the beginning service
date and each month thereafter.
ESTIMATES Occasionally bills must be estimated when a meter is inaccessible usually due to extreme weather conditions. Carmel
Utilities estimates bills only when unable to obtain readings. If plantings or structures of any kind block access to the meter pit, the
readings may be estimated until the obstruction is removed.
DELINQUENT NOTICE: A delinquent notice will be sent to any account with an outstanding balance over 45 days. This notice is a final
reminder prior to termination of service. Should you receive such a notice be sure to contact our offices immediately to verify our records if
you have made payment. If payment is not received by the due date on this notice, your water service will be terminated and you will be
charged a service fee. Ask to speak with our Delinquent Account Representative if you need assistance in resolving this debt.
HIGH USAGE: Leaks or malfunctions in toilets, water softeners, faucets, ice makers, humidifiers, and lawn sprinklers cause high usage. To
test for leaks, read your meter before going to bed and again in the morning before using any water. If the meter's reading has changed and
no water was knowingly used, a problem may exist. Toilets are most often the cause. Check to see if water is running into the tank overflow;
if it is, there is a problem. If not, add food color to the tank and check the bowl an hour later. If the dye has seeped into the bowl or is not
visible in the tank, a leak exists. If the problem continues, or you cannot find the leak, consult a qualified person to make the necessary
repairs. Carmel Utilities is not responsible for service lines from the water meter to the service address.
METER PIT: (CARMEL WATER CUSTOMERS ONLY) The property owner owns the meter pit and service lines to the residence. Carmel
Utilities and the City of Carmel own the service line from the street to the meter pit and the meter within the pit. The maintenance of the meter
pit and the remaining parts of the pit and piping are the responsibility of the property owner. From time to time you may receive notice from us
of a need to provide a service or repair to the meter pit. Usually this is a request to keep grass or any other matter from covering or interfering
with the meter pit lid or a request to replace damaged parts. Your response within 30 days of the date of the notice is needed in order to have
accurate readings of your water meter. At no time should any planting or structure be placed on the meter pit.
KEEP THIS PORTION FOR YOUR RECORDS
CITY OF CAR
CARMEL UTILITIES CUSTOMER SERVICES
WATER WASTEWATER UTILITIES PO BOX 109 (317) 571 -2442
CARMEL, IN 46082 -0109 MONDAY FRIDAY
APPROVED BY SfAEE BOARD OF ACCOUNTS FOR CITY OF CARMEL 2002 8:OOAM 5:00 PM
SERVICE PERIOD METER READINGS IN THOUSAND AMOUNT
FROM TO PREVIOUS PRESENT GALLONS BILLED
12/04/07 01/04/08 144 144E
WATER 0 $14.87
Total Location Charges For: 141ST SPRINGMILL/I $14.87
12/03/07 12/31/07 91 91
WATER 0 $14.87
Total Location Charges For: 136TH OAKRIDGE(IRR
11/30/07 01/04/08 173 173E
WATER 0 $14.87
Totai Location Charges For: 13600 SPRINGMILL RD/IRR 7 $14.87
ACCOUNT NUMBER: 0572324000 CUSTOMER NAME: CARMEL STREET DEPT
BILLING DATE 01/10/08 PAYMENT DUE BY: 01/28/08
PREVIOUS BALANCE FOR ALL LOCATIONS $0.00
CURRENT BILLING FOR ALL LOCATIONS $44.61
TOTAL AMOUNT DUE $44.61
AMOUNT DUE AFTER 01/28/08 $44.61
PAYMENTS: Payments are due at the Carmel Utilities office on the due date printed on the bill. Be sure to write your account number on
checks or money orders. Carmel Utilities charges a $20 fee for checks returned for nonpayment. Customers can pay in following ways:
Mail the payment and return stub in the envelope provided to the z
Carmel Utilities office. Allow sufficient postal delivery time as your OWH
account will be assessed penalties if it is not received in our offices by a
r_riv HAr -r.
the due date. ona1 W )X
Bring your payment and return stub to the Carmel Utilities offices in x ouNrAw
Hall during normal business hours. See ma T rI S sw
Cit
y 9 P) s�uArtr. oKOi� isoz
Drop your enveloped payment and return stub in one of our payment o
drop- boxes. (See map) z o or i ax�
Sign up for bank drafting. We will send your usual billing each month RANC1:1JN: ROAD
wlth a notation "BANK DRAFT ON DUE DATE No more check
writing and it's always on time!
RATES:
MINIMUM CHARGE The basis of this charge is the size of the meter serving the property location.
CURRENT USAGE The amount of water consumed in a billing period.
SUMMER SEWER RELIEF (Residential Property) The customer is billed for sewer usage in the months of May through October based
on the average usage for the previous months November through April. This is to adjust for the volume of water measured through the
water meter but used on lawns and other areas external to the service address and not passing through the sewer lines to be processed.
NEW CUSTOMER FEE There is a one -time service fee for new accounts of $20. The water meter will be read on the beginning service
date and each month thereafter.
ESTIMATES Occasionally bills must be estimated when a meter is inaccessible usually due to extreme weather conditions. Carmel
Utilities estimates bills only when unable to obtain readings. If plantings or structures of any kind block access to the meter pit, the
readings may be estimated until the obstruction is removed.
DELINQUENT NOTICE: A delinquent notice will be sent to any account with an outstanding balance over 45 days. This notice is a final
reminder prior to termination of service. Should you receive such a notice be sure to contact our offices immediately to verify our records if
you have made payment. If payment is not received by the due date on this notice, your water service will be terminated and you will be
charged a service fee. Ask to speak with our Delinquent Account Representative it you need assistance in resolving this debt.
HIGH USAGE: Leaks or malfunctions in toilets, water softeners, faucets, ice makers, humidifiers, and lawn sprinklers cause high usage. To
test for leaks, read your meter before going to bed and again in the morning before using any water. If the meter's reading has changed and
no water was knowingly used, a problem may exist. Toilets are most often the cause. Check to see if water is running into the tank overflow;
if it is, there is a problem. If not, add food color to the tank and check the bowl an hour later. If the dye has seeped into the bowl or is not
visible in the tank, a leak exists. If the problem continues, or you cannot find the leak, consult a qualified person to make the necessary
repairs. Carmel Utilities is not responsible for service lines from the water meter to the service address.
METER PIT: (CARMEL WATER CUSTOMERS ONLY) The property owner owns the meter pit and service lines to the residence. Carmel
Utilities and the City of Carmel own the service line from the street to the meter pit and the meter within the pit. The maintenance of the meter
pit and the remaining parts of the pit and piping are the responsibility of the property owner. From time to time you may receive notice from us
of a need to provide a service or repair to the meter pit. Usually this is a request to keep grass or any other matter from covering or interfering
with the meter pit lid or a request to replace damaged parts. Your response within 30 days of the date of the notice is needed in order to have
accurate readings of your water meter. At no time should any planting or structure be placed on the meter pit.
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))
0, w
(D 60 lti t a o
13 (DK
Total 0
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
IN SUM OF
�C)
ad
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
I5;Ld i j bill(s) is (are) true and correct and that the
11 iiA materials or services itemized thereon for
which charge is made were ordered and
received except
f ti 15 .2
t
bic? ignature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund