159732 05/27/2008 CITY OF CARMEL, INDIANA VENDOR: 358340 Page 1 of 2
ONE CIVIC SQUARE A T T LONG DISTANCE
CARMEL, INDIANA 46032 PO BOX 660688
CHECK AMOUNT: $1,273.62
DALLAS TX 75266 -0688
CHECK NUMBER: 159732
CHECK DATE: 5/27/2008
DEPARTM AC PO NUMBER INVOICE NUMBE AMOUNT D ESC RIP TION
1110 4344000 839002612 40.83 TELEPHONE LINE CHARGE
1110 4351501 839002612 679.60 EQUIPMENT MAINT CONTR
1115 4344000 839002612 10.08 TELEPHONE LINE CHARGE
1120 4344000 839002612 445.30 TELEPHONE LINE CHARGE
1125 4344000 839002612 1.17 TELEPHONE LINE CHARGE
1160 4344000 839002612 14.13 TELEPHONE LINE CHARGE
1192 4344000 839002612 17.49 TELEPHONE LINE CHARGE
1205 4344000 839002612 20.90 TELEPHONE LINE CHARGE
1301 4344000 839002612 2.40 TELEPHONE LINE CHARGE
1701 4344000 839002612 1.94 TELEPHONE LINE CHARGE
209 R4344000 839002612 3.75 ENC TELEPHONE LINE CH
2200- 4344000 839002612 4.02 TELEPHONE LINE CHARGE
2201 4344000 839002612 .32 TELEPHONE LINE CHARGE
CITY OF CARMEL, INDIANA VENDOR: 358340 Page 2 of 2
ONE CIVIC SQUARE A T T LONG DISTANCE
0 CHECK AMOUNT: $1,273.62
PO BOX 660688
CARMEL, INDIANA 46032
DALLAS TX 75266 -0688 CHECK NUMBER: 159732
ON
CHECK DATE: 5/27/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 839002612 8.41 OTHER EXPENSES
651 5023990 839002612 17.14 OTHER EXPENSES
902 4344000 839002612 2.03 TELEPHONE LINE CHARGE
911 4344000 839002612 4.11 TELEPHONE LINE CHARGE
i
I
1 1
This is a summary of the ATT Long Distance billing for: 51112008
DEPARTMENT TOTAL
Administration $14.39
CCCC
$10
Clerk Treasurer $1.94
Court $2.4
CRC $2.03
DOCS $17.49
Drugs Task Force $4.11
Engineering $4.02
Fire $445.30
Law $3.75
Mayor $14.1
MIS $6.51/
Parks $1.17
Police $720.43
Sewer $10.45 v
Sewer Dist $1.24 11/
Street $0.32'
Utilities $10.91
Water $2.92/
Water Dist $0.03
Grand Total $1,273.62
Wednesday, May 14, 2008 Page 1 of I
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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))
05/14/08 I I I $10.08
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
AT &T Long Distance
IN SUM OF
P.O. Box 660688
Dallas, TX 75266 -0688
$10.08
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1115 43- 440.00 $10.08 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
Wednesday, May 14, 2008
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
AT T long distance Purchase Order No.
P.O. Box 660688 Terms
Dallas, TX 75266 -0688 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5/20/08 monthly payment 720.43
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
A T.& T Long distance IN SUM OF
P.O. Box 660688
Dallas, TX 75266 -0688
720.43
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 440 40.83 bill(s) is (are) true and correct and that the
1110 515 -01 679.60 materials or services itemized thereon for
which charge is made were ordered and
received except
May 20 20 08
Signature
Chieffof Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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
356463
AT T LONG DISTANCE Purchase Order No.
PO BOX 660688 Terms
DALLAS, TX 75266 -0688 Due Date 5/16/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(§)) Amount
5/16/2008 5712262 $5.46
Q
hereby certify that the attached invoice(s), or bill(s) is (are) true and
orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
VOUCHER 081805 WARRANT ALLOWED
356463 IN SUM OF
AT T LONG DISTANCE
PO BOX 660688
DALLAS, TX 75266 -0688
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
5712262 01- 6360 -08 $5.46
Voucher Total $5.46
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
i.
Payee
356463
AT T LONG DISTANCE Purchase Order No.
PO BOX 660688 Terms
DALLAS, TX 75266 -0688 Due Date 5/19/2008
Invoice Invoice Description
Date Number (or note attached _invoice(s) or bill(s)) Amount
5/19/2008 571 -2255 $2.92
a
1
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
S /Z2 /vu
Date Officer
VOUCHER 081858 WARRANT ALLOWED
356463 IN SUM OF
AT T LONG DISTANCE
PO BOX 660688 0 tf
t� DALLAS, TX 75266 -0688
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
571 -2255 01- 6360 -03 $2.92
X 11
b3
Voucher Total Q
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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
356463
AT T LONG DISTANCE Purchase Order No.
PO BOX 660688 Terms
DALLAS, TX 75266 -0688 Due Date 5/16/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/16/2008 5712262 $5.45
hereby certify that the attached invoice(s), or bill(s) is (are) true and
-orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
VOUCHER 085527 WARRANT ALLOWED
356463 IN SUM OF
AT T LONG DISTANCE
PO BOX 660688
DALLAS, TX 75266 -0688
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
5712262 01- 7360 -07 $5.45
5
5712y�� 0 �.�362.05 Io.�15
Voucher Total
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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.
�o. Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
.�0
Total g0
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
V C/ IN SUM OF
/S� d /off F
qu
ON ACCOUNT OF APPROPRIATION FOR
&U
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
3 V)
q40 a 40 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
3 206
Signat re
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
AT &T Long Distance Terms
PO Box 660688 Date Due
Dallas, TX 75266 -0688
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
511108 1211568 Long Distance charges 1.17
Total 1.17
1 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
i
Voucher No. Warrant No.
AT &T Long Distance Allowed 20
PO Box 660688
Dallas, TX 75266 -0688
In Sum of
1.17
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 1211568 4344000 1.17 1 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
22 -May 2008
Si ature
1.17 Business Se es Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
,4 7 eJ. Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
A7 7��G�e c.
IN SUM OF
,Oc,A Z 7k 75a fo 6, 0 61p
ON ACCOUNT OF APPROPRIATION FOR
4 1 t� c? U t 9 /l ladcdDDP a
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
911 C/ s ou A l 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 od
Si ature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I
Prescribed by Stale Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
d ..ce Purchase Order No.
i> 6 Qmx (Q�¢��A Terms
Q� 1(45 T) Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Sft oq l6� o� 3
Total Z o 3
1 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
VOWD'HER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
Po Qox
7sz��_ o �gg
2, 6)
ON ACCOUNT OF APPROPRIATION FOR
q �Z/ 4 3 v 4eoo
Board Members
PO# or DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
16 Y3y4000 2 6 3 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
Prescribed by State Board of Accounts City Form No. 2C1 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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))
T -1 Line Long Distance $445.30
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
AT T Long Distance
IN SUM OF
P.O. Box 660688
Dallas, TX 75266 -0688
$445.30
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 43- 440.00 $445.30 1 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
4
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed,by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
5/23/08 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
AT &T Long Distance Purchase Order No.
P. 0. Box 660688 Terms
Dallas, TX 75266 -0688 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
511/08 839002612 Phone land lines long distane charges $14.13
Statement dated 5/1/08
Total $14.13
1 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.
5/23/08
ALLOWED 20
AT &T Long Distance IN SUM OF
P. 0. Box 660688
Dallas TX 75266 -0688
14.13
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayors 4344000
Telephone Line Toll Charges
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
839002612 4344000 $14.13 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
Signatpre
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
AT &T Long Distance
Purchase Order No.
P. O. Box 660688
Terms
Dallas, Texas 75266 -0688
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5 -21 -08 Telephone Long Distance Charges per the attached $3.75
Statement 5/1/2008
Total
1 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
AT&T I ONG DISTANCE IN SUM OF
P.O. Box 660688
Dallas, Texas 75266 -0688
$3.75
ON ACCOUNT OF APPROPRIATION FOR
Deferral Fee Fund
430 -44000 Telephone Line Charges
Board Members
Po# or INVOICE NO. ACCT #!TITLE AMOUNT
I hereby certify that the attached invoice(s), or
17874 Encumbered PO $3.75 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 C' X
re
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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))
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
po 5
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
MAY z 3 7008 20
y
SiY1rCtture
ni on
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 207 (Rev. 7995)
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.
A T &T Long Distance
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
UT0110 639002b ly one bervice Admin $14.39
05/0 -1108 1 d6UUUZb1j Monthly Phone Service
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 &9 23108 _WARRANT NO.
AT &T ALLOWED 20
IN SUM OF
P.O. Box 660688
Dallas, TX 75266-8688
$20.90
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1205 Administration
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
1205 839002612 440 $14.39 materials or services itemized thereon for
which charge is made were ordered and
r-ry 51
received except
20
Si at re
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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.
-7
Payee
r f�CJ Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
yr I bFs 7.
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
7. q9
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
L Z. 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
2068r
4 �"4
ign t
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
AT&T
Purchase Order No.
P.O. Box 660688
Terms
Dallas, TX 75266 -0688
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
dated 5/1/08 Long Distance Charges $4.02
Total $4.02
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
-AT&T IN SUM OF
P.O. Box 660688
Dallas, TX 75266 -0688
$4.02
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
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
n/a 5/1/08 ENG 4344000 $4.02 materials or services itemized thereon for
which charge is made were ordered and
received except
y3 20,0
ign ure
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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
7_ Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
SS IN SUM OF
1,94
ON ACCOUNT OF APPROPRIATION FOR
C 4
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
o n
0
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund