203621 11/09/2011 CITY OF CARMEL, INDIANA VENDOR: 00350084 Page 1 of 1
ONE CIVIC SQUARE TOM SMALL
CARMEL, INDIANA 46032 201 COTTONWOOD DR CHECK AMOUNT: $32.40
ray ANDERSON IN 46012 CHECK NUMBER: 203621
CHECK DATE: 11/912011
DEPARTMENT ACCOUNT PO NUMBER INVOICE N AMOUNT DESCRIPTION
1120 4343003 32.40 TRAVEL LODGING
Pu
VRC. 1 tll tYV 1 1C =I'1
1732 E 116TH ST
CARMEL, IN. 46032
IFRPIIiIAL LO.: OGiiy %OO�inu16�O$4iaO0u
MERCHANT NH: 8916403415
SALE
RECORD b: 16 IiIU: OOOO16
DATE: OCT 21, 11 TIME: 09:23
BATCH: 554
AUTH: 239071
BASE $32.40
TIP
TOTAL
THOMAS D SMALL
I AGREE 10 PAY ABOUE TOTAL AllOUIIT
ACCORDING i0 CARD ISSUER AOREFMEHT
(MERCHAHT AGREEMENT IF CREDIT VOUCHER)
CUSTOMER COPV
D x.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Tom Small
IN SUM OF
$32.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. FTNVolc E NO, ACCT #!TITLE I AMOUNT Board Members
1120 I 43- 430.03 I $32.40 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
Nov
1
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by Slate 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))
$32.40
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