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HomeMy WebLinkAbout204610 12/13/2011 CITY OF CARMEL, INDIANA VENDOR: 229650 Page 1 of 1 ONE CIVIC SQUARE OFFICE DEPOT INC CHECK AMOUNT: $635.85 CARMEL, INDIANA 46032 PO BOX 633211 CINCINNATI OH 45263 -3211 CHECK NUMBER: 204610 CHECK DATE: 12113/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4230200 1414518522 58.52 OFFICE SUPPLIES 1115 4239099 586105997001 19.20 OTHER MISCELLANOUS 1115 4230200 587389655001 154.21 OFFICE SUPPLIES 1115 4239099 587389655001 28.80 OTHER MISCELLANOUS 1115 4230200 587389708001 64.51 OFFICE SUPPLIES 1115 4239099 587389708001 53.40 OTHER MISCELLANOUS 1110 4230200 587604145001 110.49 OFFICE SUPPLIES 1110 4230200 587811924001 129.18 OFFICE SUPPLIES 651 5023990 587842821001 17.54 OTHER EXPENSES ORIGINAL INVOICE 10001 Ir ir 03rince Otflce Depot, Inc PO BOX 630813 THANKS FOR YOUR ORDER CINCINNATI OH IF YOU HAVE ANY QUESTIONS 45263 -0813 OR PROBLEMS. JUST CALL US FOR CUSTOMER SERVICE ORDER: (888) 263 -3423 FOR ACCOUNT: (800) 721 -6592 FEDERAL ID: 59 2 663954 INVOICE NUMBER AMOUNT DUE PAGE NUMBER 587604145001 110.49 Page 1 of 1 INVOICE DATE TERMS PAYMENT DUE 22- NOV -11 Net 30 25 -DEC -11 BILL TO: SHIP TO: a ATTN: ACCTS PAYABLE CARMEL POLICE DEPARTMENT m CITY OF CARMEL o CITY IF CARMEL POLICE DEPT 4 1 CIVIC SQ m 3 CIVIC SQ o CARMEL IN 46032 -2584 0 CARMEL IN 46032 -2584 IILJIII��II�„�LII llJlilll lI,I�IIIIIIIIInIILulelil,lllll ACCOUNT NUMBER PURCHASE ORDER SHIP TO ID ORDER NUMBER I ORDER DATE SHIPPED DATE 86102185 110 587604145001 21- NOV -11 22- NOV -11 BILLING ID ACCOUNT MANAGER RELEASE ORDERED BY DESKTOP ICOST CENTER 39940 ROBERT ROBINSON 1110 CATALOG ITEM fl/ DESCRIPTION/ U/M QTY QTY OTY UNIT EXTENDED MANUF CODE CUSTOMER ITEM d ORD SHP B!0 PRICE PRICE 894685 PEN, BP,RT,JETSTREAM,FN,DZ DZ 1 1 0 21.850 21.85 62152 894685 748851 Q U I C KPAC K, H P 2500 ST, LTR CT 4 4 0 22.160 88.64 112103 748851 m m 0 0 0 H m 0 0 0 SUB -TOTAL 110,49 DELIVERY 0.00 SALES TAX 0.00 All amounts are based on USD currency TOTAL 110.49 To return supplies, please repack in original box and insert our packing list, or copy of this invoice. Please note problem so ue may issue credit or replacement, whichever you prefer. Please do not ship collect. Please do not return furniture or machines until you call us first for instructions. Shortage or damage must be reported wi thin 5 days after delivery. ORIGINAL INVOICE 10001 Office Office Depot, Inc PO BOX 630813 THANKS FOR YOUR ORDER DE CINCINNATI OH IF YOU HAVE ANY QUESTIONS 45263 -0813 OR PROBLEMS. JUST CALL US FOR CUSTOMER SERVICE ORDER: (888) 263 -3423 FOR ACCOUNT: (800) 721 -6592 FEDERAL ID: 59- 2663954 INVOICE NUMBER AMOUNT DUE PAGE NUMBER 5878 129.18 Pa 1 of 1 INVOICE DATE TERMS PAYMENT DUE 23- NOV -11 Net 30 25- DEC -11 BILL TO: SHIP TO: ATTN: ACCTS PAYABLE CARMEL POLICE DEPARTMENT CITY OF CARMEL 0 g CITY IF CARMEL POLICE DEPT 1 CIVIC SGI rn� 3 CIVIC SQ CARMEL IN 46032 -2584 0 0= CARMEL IN 46032 -2584 ACC OUNT NUMBER PURCHASE ORDER SHIP TO ID ORDER NUMBER JORDER DA SHIPPED DATE 86102185 110 1 587811924001 22- NOV -11 23- NOV -11 BILLING ID ACCOUNT MANAGER RELEASE ORDERED BY IDESKTO P COST CENTER 39940 ROBERT ROBINSON 110 CATALOG ITEM U/ DESCRIPTION/ U/M QTY QTY QTY UNIT EXTENDED MANUF CODE CUSTOMER ITEM ORD SHP B/0 PRICE PRICE 231939 TONER,LJ CE285A,HP,BLACK EA 2 2 0 64.590 129.18 CE285A CE285A a m 0 0 0 0 0 ry 0 0 0 0 SUB -TOTAL 129.18 DELIVERY 0.00 SALES TAX 0.00 All amounts are based on USD currency TOTAL 129.18 To return supplies, please repack in original box and insert our packing list, or copy of this invoice. Please note problem so we may issue credit or replacement, whichever you prefer. Please do not ship collect. Please do not return furniture or machines until you call us first for instructions. Shortage or damage oust be reported within 5 days after delivery. VOUCHER NO. WARRANT NO. ALLOWED 20 Office Depot IN SUM OF P.O. Box 633211 Cincinnati, OH 45263 -3211 $239.67 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 587604145001 42- 302.00 $110.45 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 587811924001 42- 302.00 $129.18 materials or services itemized thereon for which charge is made were ordered and received except Thursday, December 08, 2011 9 Chief of Police 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 11/22/11 587604145001 office supplies $110.49 11/23111 587811924001 office supplies $129.18 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 u ORIGINAL INVOICE 10001 Off ice Office Depot, Inc PO BOX 630813 THANKS FOR YOUR ORDER CINCINNATI OH IF YOU HAVE ANY QUESTIONS 45263 -0813 OR PROBLEMS. JUST CALL US FOR CUSTOMER SERVICE ORDER: (888) 263 -3423 FOR ACCOUNT: (800) 721 -6592 FEDERAL ID: 59- 2663954 INVO ICE NUMBER AMOUNT DUE PAGE NUMBER 5_87389708001 117.91 P 1 of 1 IN DATE TERMS PAYMENT DUE 21- NOV -11 Net 30 25- DEC -11 BILL T0: SHIP TO: ATTN: ACCTS PAYABLE CITY OF CARMEL CITY OF CARMEL CITY IF CARMEL CARMEL CLAY COMMUNICATIO 1 CIVIC SQ Cn 31 1ST AVE NW o CARMEL IN 46032 -2584 M g C' CARMEL IN 46032 -1715 ACCOUNT NUMBER PURCHASE ORDE SHIP TO ID ORDER NUMBER ORDER DATE SHIPPED DATE 86102185 115 587389708001 18- NOV -11 21- NOV -11 BILLING ID ACCOUNT MANAGER RELEASE ORDERED BY DESKTOP COST CENTER 39940 JANET R. ARNONE 115 CATALOG ITEM (DESCRIPTION/ U/M QTY QTY QTY UNIT EXTENDED MANUF CODE I CUSTOMER ITEM ORD SHP B/0 I PRICE PRICE 868928 VVIPE,SUPER SANI- CLOTH,LG EA 4 4 0 13.350 53.40 i U MIPSSCO77172 868928 COMMENTS: sani wipes 673863 NOTEBOOK,THEME,CR,11X8.5, EA 8 8 0 6.560 52.48 MEA06780 673863 COMMENTS: spiral notebooks 375006 PEN,STIC,CRYSTAL,BIC,12 -PK DZ 1 1 0 4.370 4.37 BICMSI I BK 375006 COMMENTS: pens 542761 NOTE, HIGH LAN D,3X3,12 /PK,AS PK 1 1 0 7.660 7.66 MMM6549A 542761 0 N COMMENTS: post its g 0 SUB -TOTAL 117.91 DELIVERY 0.00 SALES TAX 0.00 All amounts are based on USD currency TOTAL 117.91 To return supplies, please repack in original box and insert our packing list, or copy of this invoice. Please note problem so we may issue credit or replacement, whichever you prefer. Please do not ship collect. Please do not return furniture or machines until you call us first for instructions. Shortage 0 r damage must be reported within 5 days after delivery. ORIGINAL INVOICE 10001 o on Ar 0 Ot(ice Depot, Inc nace PO BOX 630813 THANKS FOR YOUR ORDER DE CINCINNATI OH IF YOU HAVE ANY QUESTIONS 45263 -0813 OR PROBLEMS. JUST CALL US FOR CUSTOMER SERVICE ORDER: (888) 263 -3423 FOR ACCOUNT: (800) 721 -6592 FEDERAL ID: 59- 2663954 INVOIC NU MBER AMOUNT DUE PAGE NUMBER 5873896 183.01 Pa 1 of 2 INVO DATE TERMS PAYMENT DUE 21- NOV -11 Net 30 25- DEC -11 BILL TO: SHIP TO: ATTN: ACCTS PAYABLE CITY OF CARMEL m CITY OF CARMEL CITY IF CARMEL CARMEL CLAY COMMUNICATIO N 1 CIVIC SQ rn� 31 1ST AVE NW o CARMEL IN 46032 -2584 M g o CARMEL IN 46032 -1715 A CCOUNT NUMBER PURCHASE ORDER _SHIP TO ID ORDER NUMBER ORDER DATE SHIPPED DATE 86102185 115 587389655001 18- NOV -11 21- NOV -11 BILLING ID IACCOUNT MANAGER RELEASE ORDERED BY DESKTOP COST CENTER 39940 JANET R. ARNONE 115 CA TALOG MANUF CODE N/ DE CUSTOMER N ITEM U/M ORD SHP B/O I PRICE ExT PRIICE 911220 DUSTER,OFFICE DEPOT,10oz EA 5 5 LLL 0 6.290 31.45 UDS -10MS 911220 COMMENTS: canned air 143240 KLEENEX, LOTION,FACIAL,BOX EA 8 8 0 1.200 9.60 26080 143240 COMMENTS: kleenex 305706 PAD,PERF,8.5X11,OD,12PK,LG DZ 10 10 0 4.600 46.00 99400 305706 COMMENTS: legal pads 927277 MARKER, PERM,XFINE,SHARPI EA 8 8 0 0.890 7.12 35001 EA 927277 Q N COMMENTS: sharpies o 303361 PAPER,TOWEL,ROLL,2PLY,15/ CT 1 1 0 19.200 19.20 06709 303361 COMMENTS: paper towels 348037 PAPER,COPY,OD,CASE,10 -RE CA 2 2 0 34.820 69.64 8510010 D 348037 COMMENTS: copy paper ORIGINAL INVOICE 10001 on oince Office Depot, Inc PO BOX 630813 THANKS FOR YOUR ORDER POT CINCINNATI OH IF YOU HAVE ANY QUESTIONS 45263 -0813 OR PROBLEMS. JUST CALL US FOR CUSTOMER SERVICE ORDER: (888) 263 -3423 FOR ACCOUNT: (800) 721 -6592 FEDERAL ID:59- 2663954 INVOIC NUMBER AMOUNT DUE PAGE N UMBER 587389655001 183.01 Pa 2 of 2 INVOICE DATE TERMS PAYMENT DUE 21- NOV -11 Net 30 25- DEC -11 BILL TO: SHIP TO: m ATTN: ACCTS PAYABLE CITY OF CARMEL o CITY OF CARMEL CITY IF CARMEL CARMEL CLAY COMMUNICATIO 1 CIVIC S4 31 1ST AVE NW cn- o CARMEL IN 46032 -2584 C. O o CARMEL IN 46032 -1715 ACCOUNT NUMBER IPURCHASE ORDER SHIP TO ID ORDER NUMBER ORDER.DAT SHIPPED DATE 86102185 115 587389655001 18- NOV -11 21- NOV -11 BILLING ID A CCOUNT MANAGER RELEASE ORDERED BY DESKTOP ICOST CENTER 39940 JANET R. ARNONE 115 CATALOG ITEM DESCRIPTION/ U/M QTY QTY QTY UNIT EXTENDED MANUF CODE CUSTOMER ITEM TAX ORD SHP B/O PRICE PRICE rn M O O O O N W O O O SUB -TOTAL 183.01 DELIVERY 0.00 SALES TAX 0.00 All amounts are based on USD currency TOTAL 183.01 To return supplies, please repack in original box and insert our packing list, or copy of this invoice. Please note problem so we may issue credit or replacement, whichever you prefer. Please do not ship collect. Please do not return furniture or machines until you call us first for instructions. Shortage or damage must be reported within 5 days after delivery. ORIGINAL INVOICE 10001 Office 1 B Depot, Inc PO BOX 630813 THANKS FOR YOUR ORDER POT CINCINNATI OH IF YOU HAVE ANY QUESTIONS 45263 -0813 OR PROBLEMS. JUST CALL US FOR CUSTOMER SERVICE ORDER: (888) 263 -3423 FOR ACCOUNT: (800) 721 -6592 FEDERAL ID:59 2 6639 5 4 INVOICE NUMBER AMOUNT DUE PAGE NUMBER 586105997001 19.20 Pag 1 of 1 INVOICE DATE TERMS PAYMENT DUE 10- NOV -11 Net 30 11 -DEC -11 BILL TO: SHIP TO: -0 ATTN: ACCTS PAYABLE C CITY OF CARMEL ITY OF CARMEL CITY IF CARMEL CARMEL CLAY COMMUNICATIO 1 CIVIC SQ o= 31 1ST AVE NW 'C CARMEL IN 46032 2584 r 0 0 CARMEL IN 46032 -1715 I �I��I�II��II�����II���I�L�I�LI�IJ�J� tJ�JII�����IIIJtJ�I ACCOUNT NUMBER PURCHASE ORDER ISHIP TO ID ORDER NUMBER ORDER DATE SHIPPED DATE 86102185 115 586105997001 09- NOV -11 10- NOV -11 BILLING ID ACCOUNT MANAGER RELEASE ORDERED BY DESKTOP ICOST CENTER 39940 JANET R. ARNONE 115 CATALOG ITEM t!/ DESCRIPTION/ U/M QTY QTY QTY UNIT EXTENDED MANUF CODE CUSTOMER ITEM ORD SHP B/0 PRICE PRICE 303361 PAPER,TOWEL,ROLL,2PLY,15/ CT 1 1 0 19.200 19.20 06709 303361 COMMENTS: paper towels n 0 0 0 m v C, 0 0 0 SUB -TOTAL 19.20 DELIVERY 0.00 SALES TAX 0.00 All amounts are based on USD currency TOTAL 19.20 To return supplies, please repack in original box and insert our packing list, or copy of this invoice. Please note problem so we may issue credit or replacement, whichever you prefer. Please do not ship collect. Please do not return furniture or machines until you call us first for instructions. Shortage or damage must be reported within 5 days after delivery. VO NO. WARRANT NO. ALLOWED 20 Office Depot IN SUM OF P.O. Box 633211 Cincinnati, OH 45263 $320.12 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1115 586105997001 42- 390.99 $19.20 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1115 687389655001 42- 390.99 $28.80 materials or services itemized thereon for 1115 587389708001 42- 390.99 $53.40 which charge is made were ordered and 1115 587389708001 42- 302.00 $64.51 received except 1115 587389655001 42- 302.00 $154.21 Wednesday, December 07, 2011 Director 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)) 11/10/11 586105997001 $19.20 11/21/11 587389655001 $28.80 11/21/11 587389708001 $53.40 11/21/11 587389708001 $64.51 11/21/11 587389655001 $154.21 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 r ORIGINAL INVOICE 10001 Oince Office Depot, Inc PO BOX 630813 THANKS FOR YOUR ORDER DEPOT CINCINNATI OH IF YOU HAVE ANY QUESTIONS 45263 -0813 OR PROBLEMS. JUST CALL US FOR CUSTOMER SERVICE ORDER: (888) 263 -3423 FOR ACCOUNT: (800) 721 -6592 FEDERAL ID: 59- 2663954 INVOICE NUMBER AMOUNT DUE PAGE NUMBER 1414518522 58.52 Pa 1 of 1 INVOICE DATE TERMS PAYMENT DUE 23- NOV -11 Net 30 25- DEC -11 BILL T0: SHIP T0: a ATTN: ACCTS PAYABLE CITY OF CARMEL M CITY OF CARMEL 0 CITY IF CARMEL CARMEL FIRE DEPT 1 CIVIC SQ rn� 2 CIVIC SQ CARMEL IN 46032 2584 0 0 CARMEL IN 46032 -2584 ILIL L IL II 111111 a 11111 it 11 111 LIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ACCOUNT NUMBER PURCHASE ORDER SHIP TO ID ORDER NUMBER ORDER DATE SHIPPED DATE 86102185 120 1414518522 23- NOV -11 23- NOV -11 BILLING ID ACCOUNT MANAGER RELEASE ORDERED BY DESKTOP COST CENTER 39940 B 120 CATALOG ITEM DESCRIPTION/ U/M QTY QTY QTY UNIT EXTENDED MANUF CODE CUSTOMER ITEM ORD SHP B/0 PRICE PRICE Note: SPC 80105625347 Date: 23- NOV -11 Location: 0534 Register: 001 Trans 00165 209136 DVD- R,SPINDLE,100PK PK 1 1 0 17.260 17.26 32025641 Department: FIRE DEPARTMENT 798680 CASE,CD,JEWEL,SLIM PK 1 1 0 15.490 15.49 32021951 Department: FIRE DEPARTMENT 183485 CASE,JWL,CD,SLM,100 /PK,AST EA 1 1 0 20.880 20.88 32021990 a m Department: FIRE DEPARTMENT o 919185 BINDER,WJ,LT,LRR,VIEW,0.5" EA 1 1 0 4.890 4.89 N W77024PP o 0 0 Department: FIRE DEPARTMENT SUB -TOTAL 58.52 DELIVERY 0.00 SALES TAX 0.00 All amounts are based on USD currency TOTAL 58.52 To return supplies, please repack in original box and insert our packing list, or copy of this invoice. Please note problem so we may issue credit or replacement, whichever you prefer. Please do not ship collect. Please do not return furniture or machines until you caLL us first for instructions. Shortage 0 r damage must be reported within 5 days after delivery. VOU NO. WARRANT NO. ALLOWED 20 Office Depot IN SUM OF P.O. Box 633211 Cincinnati, OH 45263 -3211 $58.52 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO, I ACCT #!TITLE AMOUNT Board Members 1120 1414518522 42-302.00 $58.52 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 D E C 11 2 0 1 1 al 1 S 1 e Fire Chief 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 1414518522 $58.52 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 ORIGINAL INVOICE 10001 onwe Offic e Depot, Inc nc PO BOX 630813 THANKS FOR YOUR ORDER CINCINNATI OH IF YOU HAVE ANY QUESTIONS 45263 -0813 OR PROBLEMS. JUST CALL US FOR CUSTOMER SERVICE ORDER: (888) 263 -3423 FOR ACCOUNT: (800) 721 -6592 FEDERAL ID: 59 2663954 INVOICE NUMBER AMOUNT DUE PAGE NUMBER 587842821001 17.54 Pa 1 of 1 INVOICE DATE TERMS PAYMENT DUE 23- NOV -11 Net 30 25- DEC -11 BILL TO: SHIP T0: ATTN: ACCTS PAYABLE CITY OF CARMEL /UTILITIES CITY OF CARMEL o CITY IF CARMEL WASTE WATER TREATMENT 1 CIVIC SQ o� 9609 RIVER RD o CARMEL IN 46032 2584 0 0= INDIANAPOLIS IN 46280 -1921 o I�I��I�Ill�llu�nlln�l�lnl�l�l�l�l��l��lnlll�u���ll�l�l�l ACCOUNT NUMBER PURCHASE ORDER ISHIP TO ID IORDER NUMBER ORDER DATE ISHIPPED DATE 86102185 1 1651 1587842821001 22- NOV -11 23- NOV -11 B ID ACCOUNT MANAGER RELEASE ORDERED BY DESKTOP COST CENTER 39940 TERESA LEWIS 651 CATALOG ITEM N/ DESCRIPTION/ U/M QTY QTY QTY UNIT EXTENDED MANUF CODE CUSTOMER ITEM ORD SHP B/O PRICE PRICE 817737 REFILL,2PPD,J- D,5.5X8.5,MN EA 1 1 0 17.540 17.54 36229 -12 817737 Q m M 0 0 0 v N 0 O O O SUB -TOTAL 17.54 DELIVERY 0.00 SALES TAX 0.00 All amounts are based on USD currency TOTAL 17.54 To return supplies, please repack in original box and insert our packing list, or copy of this invoice. Please note problem so we may issue credit or replacement, whichever you prefer. Please do not ship collect. Please do not return furniture or machines until you call us first for instructions. Shortage 0 r damage must be reported within 5 days after delivery. VOUCHER 116349 WARRANT ALLOWED 229650 IN SUM OF OFFICE DEPOT INC USE THIS ONE PO BOX 633211 CINCINNATI, OH 45263 -3211 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 587842821001 01- 7202 -05 $17.54 Voucher Total $17.54 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 229650 OFFICE DEPOT INC USE THIS ONE Purchase Order No. PC) BOX 6 3321 1 1 erms CINCINNATI, OH 45263 -3211 Due Date 12/6/2011 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/6/2011 5878428210( $17.54 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 i `L /1 rr" Date Officer