203773 11/21/2011 CITY OF CARMEL, INDIANA VENDOR: 363734 Page 1 of 1
ONE CIVIC SQUARE AMY AYERS CHECK AMOUNT: $73.50
CARMEL, INDIANA 46032 13165 PLAYER CIRCLE
CARMEL IN 46033 CHECK NUMBER: 203773
CHECK DATE: 11/21/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 73.50 TIPS
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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))
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
4 n IN SUM OF
s
ON ACCOUNT OF APPROPRIATION FOR
V GNP Fw�
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
G Sts 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
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Cost distribution ledger classification if Tltle
claim paid motor vehicle highway fund