160461 06/10/2008 F CITY OF CARMEL, INDIANA VENDOR: 190300 Page 1 of 1
0 ONE CIVIC SQUARE M R S, INC CHECK AMOUNT: $5,700.00
zo CARMEL, INDIANA 46032 P 0 BOX 488
HAWESVILLE KY 42348 CHECK NUMBER: 160461
CHECK DATE: 611012008
D EPAR T MENT ACC PO NUMBER INV OICE NUMBER A MOUNT DESCRIPTION
652 5023990 527058 5,700.00 2308.00
e
1
Moffitt Re -Hab Service, Inc Invoice: 527058
PO Box 488
Hawesville, KY 42348
(270) 927 -8948
Sold Ship
to to
CARMEL WASTEWATER TREATMENT REHAB WILSON LIFT STATION
9609 HAZEL DELL PARKWAY 9609 HAZEL DELL PARKWAY
INDIANAPOLIS, IN 46280 CARMEL, IN 46280
Invoice
Account P.O. Num Ship Via Ship Date Terms Date Page
CARWASTE S10873 Net 30 5/27/08 1
Unit Extended
Item Quantity Description Price Price
1 Clean -Up and Restoration 5700.00 5,700.00"
means item is non taxable Subtotal 5,700.00
Total $5,700.00
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL s
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
190300
Moffitt Rehab Services Purchase Order No.
P.O. Box 488 Terms
Hawesville, KY 42348 Due Date 6/6/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/6/2008 527058 $5,700.00
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
r
Date Off' er
VOUCHER 085679 WARRANT ALLOWED
I
X190300
IN SUM OF
'Moffitt Rehab Services
P.O. Box 488
Hawesville, KY 42348
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
527058 02- 2308 -00 $5,700.00
De preciati on
Voucher Total $5,700,00
st distribution ledger classification if
-paid under vehicle highway fund