202266 09/27/2011 CITY OF CARMEL, INDIANA VENDOR: 358941 Page 1 of 1
ONE CIVIC SQUARE PETTY CASH BROOKSHIRE GOLF CO���g HE
0 CCK AMOUNT: $50.42
CARMEL, INDIANA 46032 C/O PAM LISTER
CHECK NUMBER: 202266
CHECK DATE: 9/27/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 38.43 FOOD BEVERAGES
1207 4350000 11.99 EQUIPMENT REPAIRS M
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))
'911ems
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.
ALLOWED 20
IN SUM OF
mod' C2
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? 1 3 9,0 -[/d bill(s) is (are) true and correct and that the
0 cPJ CPS 9 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signatur
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund