202229 09/27/2011 CITY OF CARMEL, INDIANA VENDOR: 364757 Page 1 of 1
ONE CIVIC SQUARE ANN MISNER
CARMEL, INDIANA 46032 CHECK AMOUNT: $100.00
1222 PAWIUCKET DRIVE
WESTFIELD IN 46074 CHECK NUMBER: 202229
CHECK DATE: 9/27/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 100.00 OTHER EXPENSES
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
rl n e- r Purchase Order No.
_L cL
r C i7 S f u 4z) /.y y -�h L,c t k e_ r' Terms
64_e_ 5f�F'��� -Q 7/y 7 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2v
Total d-d
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.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
O 4/" 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
0
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund