164145 09/30/2008 CITY OF CARMEL, INDIANA VENDOR: 'T359479 Page 1 of 1
Ir 0 ONE CIVIC SQUARE BECKY COFFEY CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 1402 JEFFERSON DR W
i; 46H Eon; CARMEL IN 46032 CHECK NUMBER: 164145
CHECK DATE: 9130/2008
D EPARTMENT A CCOUNT PO N INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 100.00 OTHER EXPENSES
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0
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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
Purchase Order No.
Terms
-v►� e �,j Z Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total D-t�
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.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
j
ALLOWED 20
M ;5 IN SUM OF
�C� Z tiJ ����rs� 1�', lam.
SAl 4 Cl) 3 z-.)
ON ACCOUNT OF APPROPRIATION FOR
-30 /di 6EIV
641 2- Ro4ej
RE
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
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund