160980 06/25/2008 i
CITY OF CARMEL, INDIANA VENDOR: 198900 Page 1 of 1
ONE CIVIC SQUARE MENARDS, INC
0 CHECK AMOUNT: $750.06
CARMEL, INDIANA 46032 2150 E GREYHOUND PASS
oN CARMEL IN 46033 CHECK NUMBER: 160980
CHECK DATE: 6/25/2008
DEP ARTMENT ACCOUNT PO N UMB E R INVOICE NUMB AMOUNT DESC RIPTION.
1192 4462401 1503 89.70 LANDSCAPING
1120 4239011 46236 175.85 SPECIAL DEPT SUPPLIES
2201 4238900 46530 30.52 OTHER MAINT SUPPLIES
601 5023990 46806 19.18 OTHER EXPENSES
651 5023990 47653 48.21 OTHER EXPENSES
2201 4238900 47817 21.26 OTHER MAINT SUPPLIES
°601 5023990 47929 38.49 OTHER EXPENSES
601 5023990 48376 94.53 OTHER EXPENSES
601 5023990 48378 42.91 OTHER EXPENSES
601 5023990 48420 2.79 OTHER EXPENSES
601 5023990 49437 36.76 OTHER EXPENSES
1120 4239011 96918 149.86 SPECIAL DEPT SUPPLIES
GUEST COPY RECEM
JUN 13 2008
City of Carmel i DOM
0"'RIGINAL INVOICE
Dept, of Community Services c,
G CITY /CARMEL DEPT COMM MENARDS CARMEL
DEPT. OF COMM.SERVICES 2150 E. GREYHOUND PASS
1 CIVIC SQUARE CARMEL, IN 46033
CARMEL IN 46032
FAX
INVOICE 48088 ACCOUNT: 30830264
TRANSACTION DATE 06/11/08 TRANSACTION 1503
TRANSACTION TIME 92934 PURCHASE ORDER 0
REGISTER NUMBER 7 TYPE OF SALE Charge Sale
SIGNER Nichole Passineau CLAIM 0
QUANTITY SKU DESCRIPTION AMOUNT
30.00 1891124 PEA GRAVEL 50LB 89.70
SUB TOTAL: 89.70
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 89.70
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I PICKING LIST' GUEST' COPS'
STORE tf 3083 CARM PHONE: (317) 580 -9400 CASHIER PRESS RECALL TRANS CARM 19094
2150 CAR E. ME L, IN 4 6 IO11NU PASS FAX: (317) 580 -9846 AND SCAN BARCODE IIIIIIIIIIIIIIIII
CARL, IN 4(133
GUEST NA ME ADDRESS PHO NE;
'CASHIER: PAGE 1 OF 1
City of Carmel
PLEASE STAPLE
SOLD BY: djk
DATE: !1
RECEIPT DEERE. Ph:
J
UANTITY D SKU NUMBER UNIT PRICE EXTENDED PRIC
30 EACH PEA GRAVEL 50LB 1/2 CUFT 189 -1124 2.99 89.70
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This is a quote valid today. Upon payment this quote becomes a yard picking list subject to the terms and conditions below. Quantities listed above may exceed quantities
available for immediate pick -up. Product is not held for a specific guest, but instead is available to the buying public on a first come, first serve basis. Please pickup all
purchases made on this picking list immediately. Failure to pick up products on this picking list today will result. in additional charge to if, on the day of pick up, the
retail price of the products are higher than on the day purchased. Menards liability to you is limited to refunding your original purAase price for any product not picked up.
Guest Instructions:
1. Take this picking list to a cashier to pay for the merchandise.
2. Enter the outside yard to pick up your merchandise. (AIL vehicles are subject to inspection.) PRE -TAX TOTAL: 89.70
3. Load your merchandise. (Menards Team Members will gladly help you load your materials
but cannot be held liable for damage to your vehicle.)
4. When exiting the yard, present this list to the Gate Guard. (The Gate Guard will record the
items you are taking with
5. Sign the Gate Guard's signature pad verifying you've received the merchandise.
Our insurance does not allow us to tie down or secure your load, trunk lid, etc. For your convenience, we supply twine, but you will have to decide whether or not your
load is secure and if the twine supplied is strong enough. If you do not believe the twine will suffice, stronger material can be purchased inside the store.
READ THE TERMS AND CONDITIONS CAREFULLY. All returns are subject to Menards' posted return policy. In consideration for Menards low prices you agree
that if any merchandise purchased by you is defective, Menards will agree to exchange the merchandise or refund the purchase price based on the form of original payment.
You agree that there shall be no other remedy available to you. If there is a warranty provided by the manufacturer, that warranty shall govem your rights and Menards shall
he selling the product "AS IS." Oral statements do not constitute warranties. and are not a part of this contract. The guest agrees to inspect all merchandise prior to installing
a' using it. UNDER NO CIRCUMSTANCES SHALL, MENARDS BE LIABLE FOR ANY SPECLkL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES.
NIENARDS MAKES NO WARRANTIES, EXPRESS OR IMPLIED, AS TO MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OF THE
Ib1ERCHANDISE. Any controversy or claim arising out of or relating to this contract, or the breach thereof, shall be settled by arbitration administered by the American
Arbitration Association under its applicable Consumer or Commercial Arbitration Rules, and judgments on the award rendered by the arbitrator(s) may be entered in any
court having jurisdiction thereof. The guest agrees to these terms and conditions through purchase of merchandise contained on this document.
THIS IS NOT A RECEIPT GATE GUARD SCAP•i HERE
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11 l 1 �L3 a� 8 q. �0
7E v
Total d R. 7 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.
��Y7 ALLOWED 20
IN SUM OF
C)
6�
4033
5R. 70
ON ACCOUNT OF APPROPRIATION FOR
L
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1 ,503 (pa u. O 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 200
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
GUEST COPY
G CITY /CARMEL STREET DEPT MENARDS CARMEL
3400 W 131ST ST 2150 E. GREYHOUND PASS
CARMEL, IN 46033
WESTFIELD IN 46074
FAX (317)
INVOICE 46530 ACCOUNT: 30830255
TRANSACTION DATE 06/05/08 TRANSACTION 5512
TRANSACTION TIME 135100 PURCHASE ORDER 0
REGISTER NUMBER 5 TYPE OF SALE Charge Sale
SIGNER ED MUIR CLAIM 0
QUANTITY SKU DESCRIPTION AMOUNT
1.00 5672501 CAULKSAV'R 2.98
1.00 5672501 CAULKSAV'R 2.98
1.00 5672501 CAULKSAV'R 2.98
1.00 5619760 CAULK -GUN 1 /10 1.84
6.00 5634304 3006 ULTRA ALL PURP GRAY 19.74
SUB TOTAL: 30.52
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 30.52
R
GUEST COPY
G CITY /CARMEL STREET DEPT MENARDS CARMEL
3400 W 131ST ST 2150 E. GREYHOUND PASS
CARMEL, IN 46033
WESTFIELD IN 46074
FAX (317)
INVOICE 47817 ACCOUNT: 30830255
TRANSACTION DATE 06/10/08 TRANSACTION 1068
TRANSACTION TIME 91500 PURCHASE ORDER 0
REGISTER NUMBER 7 TYPE OF SALE Charge Sale
SIGNER ED MUIR CLAIM 0
QUANTITY SKU DESCRIPTION AMOUNT
10.00 2271741 2 X 6 JOIST HANGER 18 GAU 6.40
1.00 2369630 #2 SQUARE RECESS BITS 7.48
1.00 1111024 2X6 -8' AC2 TREATED AG 3.69
1.00 1111024 2X6 -8' AC2 TREATED AG 3.69
SUB TOTAL: 21.26
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 21.26
n
VOUCHER NO. WARRANT NO.
ALLOWED 20
Menards
IN SUM OF
2150 E. Greyhound Pass
Carmel, IN 46033
$51.78
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
2201 46530 42- 389.00 $30.52 1 hereby certify that the attached invoice(s), or
2201 47817 42- 389.00 $21.26
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
Thursday, June 19, 2008
StreeAdommissioner
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))
06/05/08 46530 $30.52
06/10/08 47817 $21.26
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
GUEST COPY
GOV -CITY OF CARMEL FIRE MENARDS FISHERS
2 CIVIC SQUARE 7145 E. 96TH STREET
INDIANAPOLIS, IN 46250
CARMEL IN 46032
FAX (317)
INVOICE 96918 ACCOUNT: 31710256
TRANSACTION DATE 06/04/08 TRANSACTION 9767
TRANSACTION TIME 105155 PURCHASE ORDER 060408
REGISTER NUMBER 9 TYPE OF SALE Charge Sale
SIGNER gary carter CLAIM 060408
QUANTITY SKU DESCRIPTION AMOUNT
6.00 5690310 15 1 IX19 1 6" SILVERHVYDUTY 113.94
8.00 5690295 7 "X9 SILVER HVY DUTY 35.92
SUB TOTAL: 149.86
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 149.86
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GUEST COPY
G CITY /CARMEL FIRE DEPT MENARDS CARMEL
#2 CIVIC SQUARE 2150 E. GREYHOUND PASS
CARMEL, IN 46033
CARMEL IN 46032
FAX
INVOICE 46236 ACCOUNT: 30830283
TRANSACTION DATE 06%04%08 TRANSACTION 4945
TRANSACTION TIME 95841 PURCHASE ORDER 6 -4 -08
REGISTER NUMBER 5 TYPE OF SALE Charge Sale
SIGNER Gary Carter CLAIM 6 -4 -08
QUANTITY SKU DESCRIPTION AMOUNT
1.00 5690295 7 "X9 SILVER HVY DUTY 4.49
1.00 5690295 7'4 "X9'6" SILVER HVY DUTY 4.49
1.00 5690195 15 X19 REV. TARP 17.98
1.00 5690195 15 X19 REV. TARP 17.98
1.00 5690195 15 X19 REV. TARP 17.98
1.00 5690195 15 X19 REV. TARP 17.98
1.00 5690310 15 "X19 SILVERHVYDUTY 18.99
1.00 5690310 15 "X19 SILVERHVYDUTY 18.99
1.00 5690310 15 "X19 SILVERHVYDUTY 18.99
1.00 5690310 15 "X19 SILVERHVYDUTY 18.99
1.00 5690310 15 SILVERHVYDUTY 18.99
SUB TOTAL: 175.85
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 175.85
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Menards
IN SUM OF
2150 East Greyhound Pass
Carmel, IN 46033
$325.71
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 46236 42- 390.11 $175.85 1 hereby certify that the attached invoice(s), or
1120 96918 42- 390.11 $149.86 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
e
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))
06/04/08 46236 Tarps $175.85
06/04/08 96918 Tarps $149.86
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
z. t
GUEST COPY
G CITY /CARMEL WATER DIST MENARDS CARMEL
3450 W 131ST ST 2150 E. GREYHOUND PASS
CARMEL, IN 46033
WESTFIELD IN 46074
FAX (317)733 -2053
INVOICE 48378 ACCOUNT: 30830253
TRANSACTION DATE 06/12/08 TRANSACTION 1900
TRANSACTION TIME 101251 PURCHASE ORDER 0
REGISTER NUMBER 7 TYPE OF SALE Charge Sale
SIGNER TIM VANDERGRIFF CLAIM 0
QUANTITY SKU DESCRIPTION AMOUNT
1.00 5581712 SB ELASTOMER CRACK FILLER 6.49
6.00 5613845 MURIATIC ACID GAL 27.48
6.00 6471111 CLOROX BLEACH 96 OZ 8.94
SUB TOTAL: 42.91
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 42.91
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GUEST COPY
G CITY /CARMEL WATER DIST MENARDS CARMEL
3450 W 131ST ST 2150 E. GREYHOUND PASS
CARMEL, IN 46033
WESTFIELD IN 46074
FAX (317)733 -2053
INVOICE 48376 ACCOUNT: 30830253
TRANSACTION DATE 06/12/08 TRANSACTION 2528
TRANSACTION TIME 100833 PURCHASE ORDER TRUCK 142
REGISTER NUMBER 6 TYPE OF SALE Charge Sale
SIGNER BRUCE BUCKSOT CLAIM TRUCK 142
QUANTITY SKU DESCRIPTION AMOUNT
1.00 2352652 10' STAND RATCHET TIEDOWN 0.00
1.00 2352652 10' STAND RATCHET TIEDOWN 12.88
1.00 2356212 48 "SUPDTYBUNGEECORD -CAPAB 4.48
1.00 3648621 TOW VEHICLE SOCKET- PLASTC 7.99
1.00 3694743 14G BLK 100 THHN 15.98
1.00 3641987 INSULATED ALLIGATOR CLIPS 0.89
1.00 3641987 INSULATED ALLIGATOR CLIPS 0.89
1.00 3694769 14G RED 100 THHN 15.98
1.00 3646004 ELEC TAPE 3/4" X 60' 1.49
1.00 3649772 LIGHTED TOGGLE AMBER 1.99
1.00 3645239 14" BLK CABLE TIE 10.0 /BAG 9.99
1.00 3645239 14" BLK CABLE TIE 100 /BAG 9.99
1.00 2358010 40" -70" CARGO RETAIN BAR 11.98
SUB TOTAL: 94.53
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 94.53
V/ r
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GUEST COPY
G CITY /CARMEL WATER DIST MENARDS CARMEL
3450 W 131ST ST 2150 E. GREYHOUND PASS
CARMEL, IN 46033
WESTFIELD IN 46074
FAX (317)733 -2053
INVOICE 48420 ACCOUNT: 30830253
TRANSACTION DATE 06/12/08 TRANSACTION 2610
TRANSACTION TIME 121928 PURCHASE ORDER NONE
REGISTER NUMBER 6 TYPE OF SALE Charge Sale
SIGNER ALDWIN CASTANDTA CLAIM NONE
QUANTITY SKU DESCRIPTION AMOUNT
1.00 2355357 #18X215' SEINE TWINE 2.79
SUB TOTAL: 2.79
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 2.79
GUEST COPY
G CITY /CARMEL WATER DIST MENARDS CARMEL
3450 W 131ST ST 2150 E. GREYHOUND PASS
CARMEL, IN 46033
WESTFIELD IN 46074
FAX (317)733 -2053
INVOICE 47929 ACCOUNT: 30830253
TRANSACTION DATE 06/10/08 TRANSACTION :.7452
TRANSACTION TIME 144859 PURCHASE ORDER 0
REGISTER NUMBER 5 TYPE OF SALE Charge Sale
SIGNER GREG HOLLANDER CLAIM 0
QUANTITY SKU DESCRIPTION AMOUNT
1.00 6211300 TURBO TABLE FAN 10.86
1.00 6211300 TURBO TABLE FAN 10.86
1.00 1023154 1X3X12" WOOD STAKES 2.99
1.00- 1023154 1=12" WOOD STAKES 2.99
1.00 1719565 3 SILT FENCE 16.77
SUB TOTAL: 38.49
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 38.49
GUEST COPY
G CITY /CARMEL WATER DIST MENARDS CARMEL
3450 W 131ST ST 2150 E. GREYHOUND PASS
CARMEL, IN 46033
WESTFIELD IN 46074
FAX (317)733 -2053
INVOICE 46806 ACCOUNT: 30830253
TRANSACTION DATE 06/06/08 TRANSACTION 9540
TRANSACTION TIME 141546 PURCHASE ORDER 0
REGISTER NUMBER 4 TYPE OF SALE Charge Sale
SIGNER ANTHONY MOWERY CLAIM 0
QUANTITY SKU DESCRIPTION AMOUNT
1.00 6899930 1 -1/2" X 10' PVC PIPE 3.24
1.00 6899930 1 -1/2" X 10' PVC PIPE 3.24
1.00 6891844 1 1/2 90DEG PVC VENT ELL 1.27
1.00 6891844 1 -1/2" 90DEG PVC VENT ELL 1.27
1.00 6891844 1 -1/2" 90DEG PVC VENT ELL 1.27
1.00 6891844 1 -1/2" 90DEG PVC VENT ELL 1.27
1.00 6891844 1 -1/2" 90DEG PVC VENT ELL 1.27
1.00 6891844 1 1/2 90DEG PVC VENT ELL 1.27
1.00 6891844 1 -1/2" 90DEG PVC VENT ELL 1.27
1.00 6891844 1 -1/2" 90DEG PVC VENT ELL 1.27
1.00 6891844 1 -1/2" 90DEG PVC VENT ELL 1.27
1.00 6891844 1 1/2 90DEG PVC VENT ELL 1.27
SUB- TOTAL: 19.18
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 19.18
1
GUEST COPY
G CITY /CARMEL WATER DIST MENARDS CARMEL
3450 W 131ST ST 2150 E. GREYHOUND PASS
CARMEL, IN 46033
WESTFIELD IN 46074
FAX (317)733 -2053
INVOICE 49437 ACCOUNT: 30830253
TRANSACTION DATE 06/16/08 TRANSACTION 3776
TRANSACTION TIME 112031 PURCHASE ORDER METER SHOP
REGISTER NUMBER 7 TYPE OF SALE Charge Sale
SIGNER BRUCE BUCKSOT CLAIM METER SHOP
QUANTITY SKU DESCRIPTION AMOUNT
1.00 6602880 BOX HANDLING GLOVE XL 14.98
1.00 2521422 1 -1/4" REMGRIT HOLE SAW 9.96
1.00 2361721 1/4" DRILL BIT SIDEWINDER 2.98
1.00 2361705 7/32 11 DRILL BIT SIDEWINDER 2.38
1.00 2361608 1116" DRILL BIT SIDEWNDR 1.99
1.00 2361611 5/64" DRILL BIT SIDE WNDR 1.99
1.00 2361624 3/32" DRILL BIT SIDWINDER 2.48
SUB TOTAL: 36.76
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 36.76
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VOUCHER 082077 WARRANT ALLOWED
198900 IN SUM OF
MENARDS, INC
2150 E GREYHOUND PASS
CARMEL, IN 46033
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
48378 01- 6200 -04 $42.91
9453
q X37 b�. 3i� ZCo
Voucher Total��
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
Y
price per unit, etc.
Payee
198900
MENARDS, INC Purchase Order No.
2150 E GREYHOUND PASS Terms
CARMEL, IN 46033 Due Date 6/17/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/17/2008 48378 $42.91
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
6 /2 l
Date Officer
f
GUEST COPY
G CITY /CARMEL SEWER COLL MENARDS CARMEL
760 3RD AVE SW STE 110 2150 E. GREYHOUND PASS
CARMEL, IN 46033
CARMEL IN 46032
FAX
INVOICE 47653 ACCOUNT: 30830254
TRANSACTION DATE 06/09/08 TRANSACTION 7139
TRANSACTION TIME 134208 PURCHASE ORDER 0
REGISTER NUMBER 5 TYPE OF SALE Charge Sale
SIGNER RANDY MASSINGILL CLAIM 0
QUANTITY SKU DESCRIPTION AMOUNT
1.00 6481090 18 PK CHARMIN BATH TISSUE 10.98
2.00 6481099 15 PK BOUNTY BASIC 19.76
1.00 6481090 18 PK CHARMIN BATH TISSUE 10.98
1.00 2615971 GAL BAR AND CHAIN LUBE 6.49
SUB TOTAL: 48.21
TOTAL TAX: 0.00
PAYMENTS 0.00
TOTAL DUE: 48.21
VOUCHER 085712 WARRANT ALLOWED
`198900 IN SUM OF
MENARDS, INC
2150 E GREYHOUND PASS
CARMEL, IN 46033
z Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
47653 01- 7200 -01 $48.21
Voucher Total $48.21
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
198900 4.
MENARDS, INC Purchase Order No.
2150 E GREYHOUND PASS Terms
CARMEL, IN 46033 Due Date 6/16/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/16/2008 47653 $48.21
hereby certify that the attached invoice(s), or bill(s) is (are) true and
;orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer