HomeMy WebLinkAbout200909 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 00350140 Page 1 of 1
ONE CIVIC SQUARE INDIANA STATE POLICE
CARMEL, INDIANA 46032 C/O VICKI E KOOR FISCAL DIVISION CHECK AMOUNT: $681.00
100 N SENATE IGCN CHECK NUMBER: 200909
INDIANAPOLIS IN 46224
CHECK DATE: 8/30/2011
DEPARTMENT ACCOUN PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 5023990 681.00 OTHER EXPENSES
Prescribed by State Board of Accounts CLAIM City Form No, 291 (Aev. 1964)
A CLAIM, TO BE PROPERLY ITEMIZED MUST SHOW: KIND OF SERVICE, WHERE PERFORMED, DATES SERVICE RENDERED, BY WHOM,
RATE PER DAY, NUMBER OF HOURS, RATE PER HOUR, PRICE PER FOOT, PER YARD, PER HUNDRED, PER POUND, PER TON, ETC.
CITY OF CARMEL
On Account of Appropriation for To
Address
13 ATE OHO R ITEMIZED CLAIM DOLLARS CTS.
8 15 11 0720111 C ONTINUING EDUCATION TRAINING FUND 5
DEFERRALS 1 4 5 00
I
I i
I j
t
t
i I I
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Pursuant to the provisions and penalties of Chapter 155. Acts of 1953.
1 hereby certify that the foregoing is just and correct, that the amount claimed is legally due after allowing all
just credits, and that no part of the same has been paid.
Date August 15, 2011 19 Clerk III
SI NATURE TITLE
s
D;- bursement Summary INSUPREMEPRO
.T D
Collection Date Range: 0710112011 0713112041 Dra Copy
Carmel City Court Carmel City Court Trust Account
City of Carmel
R. s
,k. '.Y cFT.. w m•.
x.4.. t s, �r -,f; .t...= t i! s ;a d� 4. Y :9 r"•�.J rt ,a:r s'.
Y fL: ''9 ,s t ?a S:i ay�{ v Z =t
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Collection Previous Escrow Escrow Disbursement
Code Word j Description Amo u nt Escrow Deduc Held Am ount
ISPHQ Indiana State Police (Indianapoli 632.00 a.0 0.00 0.00 636.00
3'
�3s Collection Previous Escrow Escrow Disbursement
i
ty re t ,e 9 i pk.,' A mo unt Escrow Deduct H eld Amount
.r .+1 S >a�' $a`�
aWf� a far �qZ fli �c R .3�5� l3 x
632.00 4.00 0.00- 0.00
Disbursement Detail Collection Previous Escrow Escrow Disbursement
Case Number Case Style Code Amount Escrow Deductions Held Amount
S 5:'St w".
=29H01,,'1002 117 .001, 086 State.of,Indiana us JAGKiBATES ,3r. ISPHQ 4 OO :0 00 4 00"
C t. .y
29H01- 0812 -IF- 005527 State of Indiana vs. Steven M ISPHQ 4.00 0.00 0.00 0.00 4.00
Christoffersen
:29H01,- 05121F 003087. _,.A State of=lndlanaws' =Jeffe A =Dunn ISPHQ ,�.v' 4 00 0 00` 0 00 0 00 _i 4;
29H01- 0911 -IF- 005454 State of Indiana vs. Gina L Rush ISPHQ 4.00 0.00 0.00 0.00 4.00
1'•.: e i.' 'r
ISpHQ 4 00 a o0 0,00 0 00 4 as
29H01. -0.810 IF -0044 T4 r ,.State of lndlana:vs Ryan J Smoot s w K
29H01- 1012 -IF- 006136 State of Indiana vs. JOSHUA SMITH ISPHQ 4.00 0.00 0.00 0.00 4.00
=29 1101',IF- 000377 ::,State of.Indiana vs at ante Brown
H01 fSP 4 00 0:00_ 0;00 0 00
g r j'3i° .i y
:��+...a..m5.t a au r.,.tA., `R•a .wt;a,W m:.- F- ,.h. za..� .e.. W
29H01- 1103 -IF- 001167 State of Indiana vs. MONTY ISPHQ 4.00 0.00 0.00 0.00 4.00
MCDOUGAL
ndrew� D ISPH '4 00. _x,0 Oa 0 00. 4:00`
29H01:- 1K104IF 00.1.590 Statew,of¢iana
ind ,vs A u anx.r Gl F es,,
1..�. zie +sa..'�.
O {�o Y
29H01- 1005 -1F- 002397 State of Indiana vs. Timothy Kirkpatrick ISPHQ (4.00) 4.00 0.00 0.00 0.00
ISPHQ 4.00 0.00 0.00 0.00 4.00
goo'
'29H01`1f104 IF`001304 State .of.lntliana�vs„ ISPHQ�r
,.,kx^:
,.,.�t' 7 i.. :a:.v .;VRO.JHON f.: ,..r ne >k,.:.' 4:. 5:. ,x'�. "i, k. fi r. s
ti��`�. t ,s a Fr r a. ...a f .sw ,r ?d. .F. ^tom +tr.F
29H01 -1102 IF- 000774 State of Indiana vs. DREW RANKIN ISPHQ 4.00 0.00 0.00 A_ 0.00 4.00
a ARA?DULA P "H .r.= �,.4 00_...::. a. 0:00, �-4� t 0:00 a.a0
29H0State
'29H01_1103 IF'= 001:,0.,45 Sfate,of lndiana.vs ,T I�EY IS Q� .k
r�1�- 1103�IF�- -000819 ,r
of Indiana vs. Jeffrey Lamar ISPHQ 4.00 0.00 0.00 o.0o 4.00
ahluayWade
ISPHQ 40
29H01 ,1102.:IF State of Intllana_vs,.l<
29Ho1- 1102 -IF- 000706 State of Indiana vs. REYNALDO LUNG ISPHQ 4.00 0.00 0.00 0.00 4.00
aqa TS _.-r. 4.:�Cy!
.vr_a, e•
.M1 x L77'1 5 .:Y( a f...
JOSEPH €:QUICK,..,::.ISP_HQ -:,.x ,5 .:..4 00 r .,;4.40:.. 0 °00,
29H01 :1104 IF 001565 State of[ndiana ry t
t:al. i.d. w.. rr,��Y .3 ✓.:,tic -:Z ..?.:.1s L :.his .4. may... «.+.Y,. .a x La...t*�' 1 u:,,.: t. Le. J.:...:.a.., .i x s <s..:.. .r:�
29H01- 1105 -IF- 001889 State of Indiana vs. JONATHN ISPHQ 4.00 0.00 0.00 0.00 4.00
Printed on 08103/2011 at 2:50 pm Page 1 of 8
Disbursement Summary INSUPREMEPRO
R, N D
Collection Date Range: 07/0112011 0713112011 Draft Copy
Carmel City Court Carmel City Court Trust Account
City of Carmel
REYNOLDS
ndia
4'66'
0 H 0. 60 0 0�`!
W 2 0
29H01-1105-IF-001720 State of Indiana vs, ALAN STIVER ISPHQ 4.00 0.00 0.00 0.00 4,00
i
0
4
"'4" 0 -0
EB
F-00204'�7 jndiaha'iv9!.
14
l.mV
rt
;Et.' ;�A
29 H 01- 1105 -I 00 1923 State of Indiana vs. ANTHONY ISPHQ 4.00 0.00 0.00 0,00 ,4.00
SURTEES
f �?�Statdffi ia h'6,
"HILARY TOBIN 18 00
29H01- 1105 -IF- 002016 State of Indiana vs, DANIEL ISPHQ 4,00 0.00 0.00 0.00 4.00
OCA-PENALOZA
29 H0 1.
0
000 0,
a h al v s AYES.
--b b 69 6 16d'i 'EL
06! I'P LEN; H
4 00
29H01 1105 -IF- 001987 State of (ndia�n J 6 ISPHQ 4.00 0.00 0.00 0.0 4.60'
29H01,_- 1105 IF- 002028 State of
4 00
dna' v g 0 0 0 0`DO �00
2 9 H 01- 1106 -I F- 002294 State of Indiana vs. DOUGLAS BARRY ISPHQ 4.00 0.00 0.00 0.00 4.00
'6re H(
i b�bV
4.
29H01- 1106 -IF- 002501 State of Indiana vs. SUSANNA ISPHQ 4.00 0,00 0.00 6.00 4.00
THIBODEAUX
-Z
fith n"y i7 nrr, I S P H Q
29HO 1-1106-1 F-002469 State of Indiana vs. AMANDA YODER ISPHQ 4.00 0.00 0.00 0.00 4.00
29H01.1106 IF,00264`4
ow ric som 0
2 9 H 01- 1105 -I 0 01693 State of Indiana vs. JASMINA PIPER ISPHQ 4.00 0.00 0.00 0.00 4.00
00
29H01-1106-IF-002652 State of Indiana vs. Timothy Newman ISPHQ 4.00 0.00 0.00 0.00 4.00
kk
hen
JQR
"Y"
29 HO 1 -1105-1 F-002015 State of I ndiana vs. JU ISPHQ 4.00 0.00 0.00 0.00 4,00
VIELLIEU-THOMPSON
01 z '.;z"i-� ...i s )r� j bb
29H01-1106-IF-002458 State of Indiana vs. CRYSTAL ISPHQ 4.00 0.00 0.00 0.00 4.00
PORTELL
O'd
00
106 IF,, 0025.62 _•State�of,Indlana vs
o a han
:"Y"� K
29H01-1106-IF-002625 State of Indiana vs. MARK COLLINS ISPHQ 4,00 0.00 0.00 0.00 4.00
29 1,:
2 9 H 01- 1106 IF 0 02649 r. 0.00 0.00 0.00 4.00
ZW b"
hb]
eita
6- F-��
a?:.
T"
29H01-1106-IF-002310 State of Indiana vs. Jean Nuckols ISPHQ 4,00 0.00 0.00 0.00 4.00
Printed on 08103!2011 at 2:50 pm Page 2 of 8
Disbursement Summary I.NSUPREMEPRO
D
Collection Date Range: 0710112011 07131/2011 Draft Copy
Carmel City Court Carmel City Court Trust Account
City of Carmel
S, H
P
29H0.1, 9,106 IF,002282 Y State
a 0
v ER
29HOl-1105-IF-001920 State of Indiana vs. ALEJANDRO ISPHQ 4.00 0.00 0.00 0.00 4.00
RAMIREZ SORIANO
too
0
29H0,1:` NIRT
-106'rIF-'002628
Sf9i616fJ'] i""I" .4 66�
�pi
A
22
11;v,
E� 21R- 12�, 1
29H01- 1106 -1 F- 002411 State of Indiana vs. JEFFREY ISPHQ 4.00 0.00 0.00 0.00 4.00
HARBERQ
0 0
0
d
0. b
d" IS
n iana
6 I
1 5-
0
417.
p
29H0I-1106-IF-002482 State of Indiana vs. GARY BURNS ISPHQ 4.00 0,00 0.00 0.00 4.00
bb:
29H01 1106 IF= 00230.5 State vs Brent
k'
29H0I-1106-IF-002656 State of Indiana vs. William Wallace ISPHQ 4.00 0,00 0:00 0.00 4.00
0
4D
H A
b H, 6f A I r �]ndibnaj,vs -�R 6 A, W 180"HWU
KZ
R�
29H01- 1106 -IF- 002483 State of Indiana vs. DAVID RODA ISPHQ 4.00 0.00 0.00 0,00 4.00
9H 4 00
J
29H01- 1106 -IF- 002312 State of Indiana vs. Brett Renner ISPHQ 4,00 0.00 0,00 0.00 4.00
T r r
'o
a en
1`b
29H01 1`x6 1F 002317 ian
i
1 1R de
29H01- 1106 -1F- 002151 State of Indiana vs. ROXAYN ISPHQ 4.00 0.00 0,00 0.00 4,00
WILLIAMS
bo" 0
`06�
1' d lJ506LA 0
93 Stat e..o 0�
0
-4
n iana�v
�:w!7r
29H01-1106-IF-002650 State of I ndianays. Janet Billmyre ISPHQ 4,00 0.00 0.00 0.00 4.00
N 902573g'-'�N; t'�ite iiin MP., 4 00
2 iah�
d
a
29H0I-1107-IF-002755 State of Indiana vs. Phillip Hodges ISPHQ 4.00 0.00 0.00 0.00 4.00
0,
o of. n
b 0 o
29H01- 1 106 -IF- 002481 State of Indiana vs. STEPHEN ISPHQ 4.00 0.00 0.00 0.00 4.00
CARONE
-14" 6
KMOSER1:a ob'
149 r �R ;4R? W a e,b iar,
29H01- 1106 -IF- 002502 State of Indiana vs. BERNARD ISPHQ 4.00 0.00 0.00 0 .00 4.00
DUNKEL
6
n iankvs�� .'o t. .,C
Hil
29H01-1106-IF-002101 State of I ndiana vs, Michael Talley ISPHQ 4.00 0.00 0.00 0.00 4.00
Z
2 9 H 01- 1105 -1 F- 00 1968 State of Indiana vs, David Higgins ISPHQ 4.00 0.00 0.00 0.00 4.00
zii�o 0
H�!_ UP
29H01-1106-IF-002166 State of Indiana vs. John Delano ISPHQ 4.00 0.00 0.00 0.00 4,00
Printed on 0810312011 at 2: prn Page 3 of 8
Disbursement Summary INSUPREMEPRO
A D
Collection Date Range: 07/01/2011 07/31/2011 Draft Copy
Carmel City Court Carmel City Court Trust Account
City of Carmel
2 9 H 0 1 N
b DI 00
1, J �1 0 5:r, I iah
8 of 0
I �d ANA'
j COLLINS
29H01- 1105 -IF -001967 State of Indiana vs. STACIA YEOMAN ISPHQ 4.00 0.00 0.00 0.00 4.00
ISPHQ, 0.
e q u 0
000 00'
��Hdvi'4b� 0027 Th
F 6': I ndiana brnaV' h'
man 1
291-101-1107 -IF-00267'9 State of Indiana vs. RICHARD BEHAN ISPHQ 4.00 0. 0,00 0.00 4.00
0'00 00
'00
29H01- 1 105 -IF- 002043 State of Indiana vs. CARRIE DAVIS ISPHQ 4.00 0.00 0,00 00 0.00 4.00
4 06
441
�0'0
6 002545 d'
a
29H 7
U
k�
29H01 1105 -I F- 002004 State of Indiana vs. DONALD ISPHQ 4.00 0,00 0.00 0.00 4.00
RANDALL
9 1 i -WI L,L AW 0: �"N" n p. .3 bd
-W ��rLE N 18 0 0:` �4
R -PUL- -001 �"N --�I:u4l'00'
and, -n H
q
29 HO 1 -1106-1 F-002268 State of Indiana vs, ARTHUR ISPHQ 4.00 0:00 0.00 0.00 4,00
MCKINLEY
'0'0,�
'�'tanky ISPHQ
,2- L:iT1,06.
W! Ind iana�vs. M E D I N
29HOl-1106-IF-002655 State of Indiana vs. Jordan 4,00 0.00 0.00 0.00 4.00
0
C a L J.,
ISPH
29H01- 1106 -1F- 002633 State of Indiana vs, JAMIE STEINER ISPHQ 4.00 0.00 0.00 0.00 4,00
RK2ff�q��Pekb ,N iarialkVs� Y' r
0C)l
rinOtt&.Wo 90�0 00�' ',A
29H01-1106-IF-002424 State of Indiana vs. COLLEEN ISPHQ 4.00 0.00 0.00 6.00 4.00
THOMAS
�21H bO'
29H01- 1107 -IF- 003034 State of Indiana vs. Gralyn Hebert ISPHQ 4.00 0.00 0.00 0.00 4.00
29H01 ;11Q7 IF- 003027 �4
H
Z� -WOU.
t f 1
a er.o n iana
ws%
e A�
.7v
D:: Z-
29HOI-1107-1�-'0028�� State of Indiana vs. 6AVIDBETINVIEH ISPHQ 4.00 0.00 0.00 0.00 4.00
'H
.00
10- Q,
fi T� �L7
n
`29HI01-1105-IF-001906 State of Indiana vs. KENNETH ISPHQ 4.00 0.00 0.00 0.00 4,00
KUNKEL
4 0I
ig A 0 0,
Stal RANDO
I *S P
A
O'H
HQ'
2 9 H 01- 1106 -I F -002 State of Indiana vs. Braridon Senseney ISPHQ 4.00 0.00 0.00 0.00 4.00
b bqq`-"
.00
4 t.
29H01-1106-IF-002263 State of Indiana vs. Hassaun Todd ISPHQ 4,00 0.00 0.00 0.00 4.00
M od"-
4.� 1 ;1 11��
002580 n a X 6.1
NStaU
f .0
OLL
gjSRHQ
Printed on 08/03/2011 at 2:50 prn Page 4 of 8
Disbursement Summary |NSUPREMEPRO
D
Collection Date Ra 0710112011 07131/2011 Draft Co
Carmel City Court Carmel City Court Trust Account
City of Carmel
20H01'1107-|F'802881 State of Indiana vs. RICHARD |SPH<] 4.00 000 0.00 8.08 4,08
BELLOWS
29HO1-1107'|F'002780 State of Indiana vs. CHARLES |SPHC> 4.80 0.00 0�UD U�0O 4.00
GORDON U|, U|
20HO1'1107'|F-003269 State of Indiana vs. RONALD MUMAVV |SPHQ 4.00 0.00 0.00 0.00 4.00
29H01'1107-|F'003115 State of Indiana vs. DONALD |SPHO 4.00 0,00 8.80 U0 4.00
MOREHOUS
29HOl-1 107-IF-002851 State of Indiana vs. Derek Roese��r (SP`HQ 4.00 0.00 0.00 0.00 4.00
pZ 4 00
29HO14108'|F-002854 State of|ndianavS�Br�Od�8D�U |GPHC> 4�OO O�DO 0.00 0.00 4.00
29HOl-1107-IF-0031 19 State of Indiana vs. JAMES CLARK ISPHQ 4,00 0.00 0.00 0.00 4,00
29 H 0 1 1106-1 F-002624 State of Indiana vs. BRIAN BLOUGH ISPHQ 4.00 0.00 0.00 0.00 4.00
tg
29HOl-1107-IF-003036 "State ofIndiana vs. Tayfor Biddle ISPHQ 4.00 0.00 0.00 0.00 4.00
29HOI-1107-IF-003144 State of Indiana vs. Kirsten Mains ISPHQ 4.00 0.00 0.00 0,00 4.00
29HOI-1 107-IF-002777 State of Indiana vs. Michael Seufert ISPHQ 0.00 0.00 0,00 0.00 0.00
|SPH(J 4,00 0.00 8.00 0.00 4.00
29HOl-1106-IF-002497 State of Indiana vs. JAMES` ISPHQ 4.00 0.00 0.00 0.00 4.00
BETHURAM
29HOl-1 I 07-IF-003105 State of Indiana vs. Jerry Schulenburg ISPHQ 4.00 0,00 0.00 0.00 4.00
Printed on0D03/2U11at2:5Opm Page Onf0
Disbursement Summary |N3UPREMEPRO
D
Collection oaten 0710o011 0713112011 Draft Co
Carmel City Court Carmel City Court Trust Ao^o"m
City ofCarmel
29HOl'11OG'|F-OO214G State of Indiana vo�Susan VN|aon |SPHO 4�OO 0�OO 0.00 0.00 4.00
O�0D�
29HO1-1106'|F-002506 State of Indiana vs. A�AOOU |SPHC\ 4.00 0.00 0.00 8.80 4.00
BOCOUM
Oj]O
HAE L�.�.
29HD1'1106-F-002817 Stab�of|ndiunavo�FEL|X6OKA|S |SPHC> 4�OO 0.00 0.00 0.00 4. O0
iana D'UO��
29H01-1106'|F'002495 State of Indiana vs. L|NDSEYSAXTDN |GPHO 4.00 0.00 0.00 0.00 4.U0
o
29HOl-I 106-IF-002470 State of Indiana vs. STEVEN LEE ISPHQ 4.00 000 0.00 0,00 4.00
29HO1'1106'|F'002148 State of Indiana vs. CLAYTON COOK |SPHO 4.00 0.00 0,00 0.00 4.00 0 ]h6ana',V9Joh 29HOl-1 107-IF-003288 State of Indiana vs. Adam Haladaj ISPHQ 4,00 b.00 0.00 0.00 4.00
`^8�0
29HO1-1107'|F'002903 State of Indiana vs. Scott Anderson |SPHQ 4.00 0.00 0.00 0.00 4.00
�UD(�^�'
29HU1-1107'|F'003243 State of Indiana vs. ThacNguyen |8PHC> 4.00 0.80 0.00 0.80 4.00
26�61-1106'-'IF-602280 State of Indi vs. N4NCl WARD ISPHQ 4.00 0.00 0'. 0 0.00 4. 00'
29HOI-1 106-IF-002474 State of Indiana vs. JANEEN ISPHQ 4.00 0.00 0.00 0.00 4.00
VVOELFER
29HOI-1 107-IF-002901 State of Indiana vs. Cheryl !�paulding ISPHQ 4.00 0.00 a6b 0.00 4.00
29HOl-1107-IF-002765 State of Indiana vs. David Kiauer ISPHQ 4.00 0.00 0.00 0.00 4.00
29HOI-1107-IF-003040 State of Indiana vs. Douglas Seagraves ISPHQ 4.00 0.00 0,00 0.00 4.00
29HOl -1 106-IF-002568 State of Indiana vs. MARILYN BOTKIN ISPHQ 4.00 0.00 0.00 0.00 4.00
Printed unO8103/u011au2:5Vpm Page 5of8
Disbursement Summary INSUPREMEPRO
R D
Collection Date Range: 07101/2011 07131/2011 Draft Copy
Carmel City Court
—.an.
Totals: 632.00 4.00 0.00 0.00 636.00
Printed on 08/0312011 at 2:50 pm Page 7 of 8
Disbursement Summary INSUPREMEPRO
r� D
_,oC� Collection Date Range: 07/0112011 0713112011 Draft Copy
Carmel City Court
Recipient Collection Previous H Escrow (-)Escrow Held Disbursement
Amount Escrow Deductions Amount
n,
00s_�'
Total 632.00 4.00 0.00 0.00 636.00
Printed on 08103/2011 at 2:50 pm Page 8 of 8
Deferral By Agency (Payments)
Carmel City Court
July 2011
Agency Indiana State Police (Indianapolis)
Case Number Defendant Amount
29H01- 1105 -IF- 001999 SCHUSTER, DANIEL R, Jr. $170.00
29H01- 1105 -IF- 002002 BRAY, NIKKI L $170.00
29H01- 1105 -IF- 002041 SIMON, MICHAEL $110.00
29H01- 1106 -IF- 002314 Schmicker, Tristan T $110.00
29H01- 1106 -IF- 002467 MEADOWS, MICHAEL R $140.00
29H01- 1106 -IF- 002473 MUNSON, WESLEY G $110.00
29H01- 1106 -IF- 002590 DZIERLA, PATRICIA A $170.00
29H01- 1107 -IF- 002726 SCHULTZ, AMY M $110.00
29H01- 1107 -IF- 002862 LOVE, CONNOR G
Sub Total: $1,230.00
Grand Total: $1,650.00
Page 2 of 2
Prescribed by State Board of Accounts CLAIM City Form No. 201 (Rev, 1961)
A CLAIM, TO BE PROPERLY ITEMIZED MUST SHOW: KIND OF SERVICE, WHERE PERFORMED, DATES SERVICE RENDERED, BY WHOM,
RATE PER DAY, NUMBER OF HOURS, RATE PER HOUR, PRICE PER FOOT, PER YARD, PER HUNDRED, PER POUND, PER TON, ETC.
CITY OF CARMEL
On Account of Appropriation for TO
Address
DATE ORDER -r ITEMIZED CLAIM DOLLARS CTS.
19 NO.
6316 66
8/1V11 072011, C EDUCATION TRAINING FUND
DEFERRALS i4 5 00
I i I
CLAIM NO. WARRANT NO.
I N FAVOR OF I have examined the within claim and hereby
certify as follows:
That it is in proper form.
That it Is duly authenticated as required by law.
contract
That it is based upon
statutory authority
correct
That It is apparently
incorrect
ON ACCOUNT OF APPROPRIATION Clerk- Treasurer
FOR
CD w n
I C m
CL
m
C N
C1
o m
3 m m
w
ALLOWED 19
CL Z
a
IN THE SUM OF
f
i i o c
m
w
n o Ca
w a
n F
o
j y o
7
7 ID
I n
4 m
CD
o c
F
m
7 U N
BOARD OF TRUSTEES o
n n
0 Q Cu
A_ C w
COST DISTRIBUTION LEDGER CLASSIFICATION
C1 m d
IF CLAIM PAID MOTOR VEHICLE HIGHWAY FUND ,D y w
v
ACCT.
ACCOUNT TITLE AMOUNT
o
of
n
m
W 3
n
c
m
4
O
A
f 3
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BOVCE FpquB•BVSTE481JdDjSi /lM 1.1]
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
v -t�Ge� Purchase Order No.
a.-
/h C"'7 N Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
(O v
Total
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.
y� D ALLOWED 20
me IN SUM OF
J-M 0,J,
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
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VW 20
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Cost distribution ledger classification if
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claim paid motor vehicle highway fund