HomeMy WebLinkAbout204683 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 00351435 Page 1 of 1
ONE CIVIC SQUARE SPRINT
o CARMEL, INDIANA 46032 PO BOX 4181 CHECK AMOUNT: $2x4.34
CAROL STREAM IL 60197 -4181
CHECK NUMBER: 204683
CHECK DATE: 12/20/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1401 4344100 148239816048 146.91 48239816 -048
1701 4344100 148239816048 97.43 148239816 -048
YOUR SPRINT INVOICE
ACCOUNT INFORMATION CUSTOMER CARE
Account Name Invoice Date Register and Logon
CITY OF CARMEL COUNCIL December 10, 2011 www.sprint.com
Account Number TIN Number Call Sprint
148239816 47- 0882463 1- 877 639 -8351
Invoice Number ABA Number Total Amount:Due.
148239816 -048 111- 000 -012 $734 42
SPRINT NEWS
AND NOTICES
MONTHLY INVOICE SUMMARY This section contains
important updates about you
November 07 December 06, 2011 Sprint Services, including
Previous Balance 244.34 Service or Rate Changes,
Payments as of 12/08/11 -Thank you -244.34 Promotions and Offers.
Outstanding Balance $0.00
Correspondence
0001- Access and Related Items 327.25 Please send all correspondence
0006 Equipment and Retail Purchases 399.98 including billing inquiries to:
0007 Sprint Surcharges 7.04 Sprint Customer Service
0008 Government Fees and Taxes 0.15 PO Box 8077
London, KY 40742
Total Current Charges for 148239816 -048 Due 12/30/11 $734.42 Do not enclose your payment
Total Amount Due $734'' 42
with a correspondence.
You may also contact Sprint
Customer Care at the number
listed on your invoice or by
going to sprint.com
'Any unpaid balance after the due date may be subject to a late payment charge
per your contract.
0157782/8 III�IIIIII�IIIIIIIIIIIIIIII III�IIIIIIIIIIIII
Account Number Page
YOUR SPRINT INVOICE Account 4oi16
Account Name
CITY OF CARMEL COUNCIL
SPRINT NEWS AND NOTICES CONTINUED
Network Management Practice
The FCC issued rules adopting net neutrality
standards. A FAQ was written to help customers
better understand our network management
practices. The FAQ shows how Sprint maintains a
transparent and open internet experience. To view
the FAQ, visit s print.com /networkmanagement
Rates: International, U.S. Territories
possessions
Rates, including associated roaming rates, for
International, U.S. Territories and possessions,
are subject to change from time to time without
notice. Visit s print.com /international for the current
voice, text and data rate information.
Software Updates Available
Keep your phone's software current by checking
for updates regularly. Log on to ssp rint.com any
time to check your alerts or go to sprint.com /learn
and follow the instructions for your phone. That's
getting it done right now.
Hearing Aid Compatibility
Sprint offers a variety of handsets that have been
rated for compatibility with several types of
hearing aids. Please visit sp rint.com /accessibility_
for more information.
BILLING FOOTNOTES
Time Period PP Peak Period." OP Oif Peak?Pariod MP MulilplePertod
Features CW Call Waiting CF Call Forwarding 3VJ Three Way Calf DS Dial up Service tvlfdl fvlobtle to Mobile
SH S rini TO Home SO- Sprint 7oQttice AC Audio Conferencing LD Long Distance OS- OperatorServices
WI fireless Integration DA Directory Assistance yYC Any Mobile Anytime
Networks NN National Netrvofk oC outotHomeArea Iii International Roamm WD= Worldwide Dlscourt TJ Ti uana Network
OA Out o(Area f� fZoammg_ SA Sprint Airave
9 l
Servic ®a AL Alternate Line
AU Anytime7Pian Usage PF.PartlaL F FC Free Call WP Wireless; Priority
YO UR S I N V O K E S
Account Number Billing Period age
148239816 11 /07/11-12/06!11 of 16 \11
Account Name Invoice Date Invoice Number Sp rin t'
111
CITY OF CARMEL COUNCIL December 10, 2011 148239816.948 p i i
ACCOUNT SUMMARY
Monthly Direct Connect Messaging Data and
Recurring Service Cellular LID and Other Directory Svcs. Number of Third Party Equipment and Government
Access Discount/ Minutest Minutest Assistance Minutes/ Messages/ Services K8! Retail Sprint Fees and
Charges Adjustments Charges Charges Charges Charges Charges Charges Purchases Surcharges Taxes Totals
A ccount C h a rges an d Adj
1148239816 CITY OF CARMEL COUNCIL S399.98 5399.98
Subscriber Charges and Adjustments
Number/ Plan Page
Name
317- 656.7989 Everything Data Share 1500 -32.50 12,607.00
ERIC SIDENSTICKER 7 147.99 2.94 0.03 118.46,
317-2011-1010 Everything Data Share 1500 498:00 307 9, 032.00
DIANA CORDRAY 7 27.99 0160 0.03 28.62
317-201-9922 Everything Data Share 1500 288:00 39,905.00
JOHN ACCETTURO 9 27.99 0.60 0,03 28.62+
317- 513.0242 Everything Data Share 1500 10:00 12,555,00
LUCISNYDER 11 0.03 0.03
317 714 -2721 Everything Data Share 1500 814;00 2:00 641 577,066.00
CINDY SHEEKS 11 67.98 0.60 0,03 68.61
317-496-0453 Bus Advantage Msg Data 900 -12.75 1
CAROL SCHLEIF is 56.65 1.15 45,05
317 -496 -2811 Bus Advantage Msg Data 900 -12.75
SUE FINKAM 16 66.65 -1 .15 45.05
Usage for All Subscribers 1610:00 2:00 948 651,165.00
Discounts for All Subscribers S58.00
Charges for Ali Subscribers $385.25 $7.04 $0.15 $334.44
Total Current.11eage. t610;00.. 2 00,'. s49'; 651,7`85 00
Tetsf Current Chergea $385 25 S58 00
0# 1 SO 15 $734 42
Total Subscribers on Account 7
If you prefer to receive a Summary Invoice, please visit sprint.com, log into My Sprint, and select the "Change how detailed your bill is" option or
contact Customer Care. The Summary Invoice is designed for your convenience, and will not display full billing details.
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c D SPRINT I C Account Number Billing Period Page
148239816 11107/11- 12/06 111 6of16
YO
Account Name Invoice Hate Invoice Number Sprint
CITY OF CARMEL COUNCIL December 10, 2011 148239816 -048
ACCC3UNT CHA... AND ADJUSTIVIEt�IfiS
ACCOUNT MANAGEMENT REPORTS
The following reports are compiled as a courtesy to help you analyze usage trends and manage your account activity.
ACCOUNT ACTIVITY SUMMARY Usage Summary
Shared Services Usage
Date R Amo
Usage Additional
PREVIOUS INVOICE ACTIVITY ID Usage Type Included Used Billed Charges
LT0100 Anytime Minutes 1,500 495 0
Previous Balance $244.34 Total Additional Charges $0.00
Payments Toward Previous Balance You can view Price Plan information and all breakout of minutes by subscriber in the Subscriber Informational Reports section under
Payment Check 203693 11/20/11 -244.34 each phone number.
Dates presented next to a Usage Category indicates that every subscriber on the shared plan moved to a different plan.
Total Payments $244.34
Pooled Services Usage
Qutstandin4 Balance $0 00:
Usage Additional
R ate/Date Quantit Amount iD Usage Type Included Used Billed Charge
XDI i Anytime Minutes 11/15. 12101 1,800 0 0
CURRENT INVOICE ACTIVITY Total Additional Charges $0.00
or Dates presented next to a Usage Category Indicates that every subscriber on the pooling plan moved to different plan.
Equipment and Retail Purchases Total charges has already applied any pooled usage adjustments.
Equipment Order DM14 -0- 025294419 399.98
Single Services Usage
Total Equipment and Retail Purchases $399.98 Additional
Usage Type Used Billed Charges
Current Balance $399 9t3
Any Mobile, Anytime 868 0
Text
ACCOUNT ACTIVITY DETAILS Nght&.Weekend 91 7
Picture Mail 39 0
Sprint 3G Data 622,613 0
°r
Equip Char es SerVIC2S Sprint 3G Data Roaming 28,552 0
Sprint 4G Data 0 0
Sprint Order Number Shipping Address Total Additional Charges S0.00
DM14 025294419, 11/14/11 1 CIVIC Single Services Usage grid includes any service that does not have an included allowance.
CARME, IN 46032 Single Services Usage grid includes usage from all non shared /pooled plans and services including any non shared services that are
associated to a shared, sharing group, or pooling plan
Actual Plan Discount Report
Descripti Quanti SRP SRP Total Ch T otal Discounted Extended
SAMSUNG D710 HANDSET KIT 2 199.99 399.99 'Discount Associated Plan Discounted
Subtotal $399.99 Subscribers Plan Amount Code Di Amount Amount
Sales Tax 0.00 1 Everything Data Share 1500 129.99 CNVP25 32.50 97.49 97.49
Total $399.98 Total Plan Discount $97.49
Less Amount Paid 0.00
'MULTIPLE -When more than one discount plan Is attached to the rate plan.
Total Equipment Charges Services $399.98 Note: This summary report represents current numberof subscribers with monthly plans and associated discounts active at the time
of billing.
Your Extended Discounted Amount was subtracted from your Monthly Recurring Charges.
i
Account Number Billing Period Page
YOUR SPRINT INVOICE 148299816 11- 12!06/11 7ot16
Account Name Invoice oice D ate Invoice Number Sp ri nt'
CITY OF CARMEL COUNCIL December 16, 2011 148239816 -048
SUBSCRIBER CHARGES AND ADJUSTMENTS your Rate Plans
317 -1656 -7989, ERIC SIOENSTIGKER d
Plan Services
VotceMail Include Enhanced Voice Mai
Required Features with Plan
SUBSCRIBER ACTIVITY SUMMARY BverythingDataShare1500 Call Detail
Caller ID
Do mastic LID Rate $0.
Billed Usage Rate /bate Amount Anytime Minutes
Jlr111 Monthly Recurring Access Charges Unlimited Nights &Weekends -7pm Modified Nights and Weekends
Cellular Minutes
Everything Data Share 1500 for 12/07 -01 /06 129.99 Unlimited Any Mobile A nyti m e I Any Mob ile Anytime
Premium Data $10 add -on charge for 12/07 -01/06 10.00 Subscriber Usage Summary
TEP ($4 Ins. premium ESRP) for 12/07 -01/06 8.00
Shared services Plan Everything Date
Total Monthly Recurring Access Charges $147.99
Usage Additional
fi11I Service Discounts ID Usage Type Included Used Billed Charges
Busin Disco Sprint 25% -32.50 LTD 1007 Anytime Minutes Shared 0 0 Shared
Any Mobile, Anytime Unlimited o
Total Service Discounts
$32.50 Text Unlimited o
Sp rint Surcharges Night Weekend i Unlimited 0
P 9 Picture Mail Unlimited 0
Federal -Univ Sery Assess Non -LQ 3.750 1 97 Sprint 3G Data Unlimited 12,607
State -Univ Sery Assessment 0.300% 0.16 Sp 3G Data R oa m i ng Unlimited o
Total Additional Charges S0100
State Gross Receipts R 1.400 0.81 To view total charges and usage, please go to the Account Level Usage Summary. To view your phone additional charges, please
Total Sprint Surcharges $2.94 go to the Subscriber Activity Summary for this phone
'Sprint Surcharges are rates we choose to collect from you to help defray costs imposed on us. Surcharges are not taxes or Dates next to a Usage Type indicates a pricetplan change.
amounts we are required to celtect from you by law. Surcharges may include: Federal USF, regulatory charges,
administrative charges, gross receipts charges, and other charges incurred to recover costs associated with governmental
programs. The amounts, and the components used to calculate Surcharge amounts, are subject to change.
Government Fees and Taxes
31 1.1010 DtANA!CORDRAY
State He Impaired Charge 0.03
Total Government Fees and Taxes $0.03 SUBSCRIBER ACTIVITY SUMMARY
TOW Charges for ER[C SI�ENSTIC#(ER
Billed Usage RatetDate Amount
Monthly Recurring 1 C
SUBSCRIBER INFORMATIONAL REPORTS ;tII
Everything Data Share re 1500 1500 for r 12 /07 12/07 01 /06 19.99
The following reports are compiled as'a courtesy to he y ou analyze usage trends and manse our subscriber activit TE P ($4 Ins. premium ESRP) for 12/07 01/06 8.00
9 P P Y PY Y 9 9 Y Y
Total Monthly Recurring Access Charges $27.99
Your Rate Plans Sprint Surcharges
Plan Services Federal -Univ Sery Assess Non-LO 3.750% 0.40
Premium Data $10 add-on charge America Roaming Included State -Univ Sery Assessment 0.300 0.03
SMS Text Messa *•State -Gross Re Rec overy 1.400%- 0.17
Long Distance While Roaming
Total S print Surchar es
Mobile TV P 9 I $D 60
Sprint 4G Data. Services Sprint Surcharges are rates we choose to collect from you to help defray costs imposed on us. Surcharges are not taxes or
Sprint 3G Data Services amounts we are required to collect from you by law. Surcharges may include: Federal USF, regulatory charges,
administrative charges, gross receiptslcharges, and other charges incurred to recover costs associated with governmental
Dom foaming Packet Data iQ�s programs. The amounts, and the components used to calculate Surcharge amounts, are subject to change.
Video Mail
Continued...
Q157784/8 IIII III II
I
Account Number Billing Period Page
YOUR SPRINT INVOICE Account 11 voice 1- 12/06111 In 11 of
ice e n
i VV SPRINT II ISM Y Account Name Invoice Rate Invoice Number Sprp t
CITY OF CARMEL COUNCIL December 10, 2011 146239816 -048 m
317 -201 -9922, JO HN ACCETTURO Cont. SUBSCRIBER INFORMATIONAL REPORTS
SUBSCRIBER INFORMATIONAL REPORTS The following reports are compiled as a courtesy to help you analyze usage trends and manage your subscriber activity.
Your Rate Plans
S ubscriber Usage Summary
Plan Services
Shared Services Plan Everything Data Data/MsglAmer Roam /GPS Nav America Roaming included
Usage Additional SMS Text Messages
ID Usage Type Included Used Billed Charges Long Distance While Roaming
Sprint 3G Data Unlimited 39,905 Mobile TV
Sprint 30 Data Roaming Unlim 0 Sprint 3G Data Services
Total Additional Charges $0.00 Dom Roaming Packet Data Kbs
To view total charges and usage, please go to the Account Level Usage Summary. To view your phone additional charges, please _Video Mail
go to the Subscriber Activity Summary for this phone. VoiceMail Included Enhanced VeloeMail
Dates next to a Usage Type indicates a price plan change. Required Features with Plan
Everything Data Share 1500 Call Detail
Caller ID
Domestic LD Rate $0
317 51:3 4242 LUCI SNYDER
Unlimited g s &Weekends p
t_ Ni ht 7 m Modified Nights and Weekends es
Cellular Minutes
SUBSCRIBER ACTIVITY SUMMARY Unlimited Any Mobile, Anytime Any Mobile Anytime
Subscriber Usage Summary
Billed Usage Rate /Date Amount Shared Services Plan Everything Data
Government Fees and Taxes Usage Additional
State Hearing Imp Charge 0.03 ID Usage Type Included Used Billed Charges
LTD 1007 Anytime Minutes Shared 5 0 Shared
Total Government Fees and Taxes $0.03 Any Mobile, Anytime Unlimited 5
Totat Chargesfor LUCI SNYCER
Text Unlimited 0
Night Weekend Unlimited 0
Picture Mail Unlimited 0
Sprint 3G Data Unlimited 12,533
Sp 3 Da ta Roaming Unlimited 22
SUBSCRIBER ACTIVITY DETAIL Total Additional Charges $0.00
To view total charges and usage, please go to the Account Level Usage Summary. To view your phone additional charges, please
To view coverage maps and rates visit Sprint.com. go to the Subscriber Activity Summary for this phone.
Dates next to a Usage Type indicates a price, plan change.
Cellular Services Call Detail
ell
Footnote Long Dist./ Total
No. Date Time Call To Number (See pg. 2) Min:Sec Usage Other Charges
1 11(08 12:18P Incoming 317.902 -1594 PP /WC /AU 5:00 0.00 0.00 0.00 317 714 272 CINDYSHEE,KS
2 11122 02:41P Incoming 317- 238 -6293 PP /AU 5:00 0.00 0.00 0.00
Total Cellular Services Charges 10:00 $0.00 $0.00 S0.00 SUBSCRIBER ACTIVITY SUMMARY
*Long Distance/Other column includes any Long Distance, Directory Assistance (411), and Out of Area charges.
Total minutes used may not be the same across all invoice sections due to the presence of non chargeable calls.
Billed Usage Rate/Date Amount
'dll Monthly Recurring Access Charges
Everything Data Share 1500 for 12/07 01/06 19.99
Premium Data $10 add -on charge for 12107 -01/06 10.00
Sprint Mobile Hotspot for 12%07-01106 29.99
Continued_.
015778618 III [��I IIII I II IIIIII I �ll I II]I 1 I�I III i
I
Account Number Billing Period Page
YOUR SPRINT INVOICE 148239816 11107!11- 12/0 15 of 16 tll
Account Name Invoice Date Invoice Number Spri nt CITY OF CARMEL COUNCIL December 10, 2011 148239816 -048
317.714.2721, CINDY SHEEKS cont. 317 496;0453 CAROL SCHLEIF
SUBSCRIBER INFORMATIONAL REPORTS SUBSCRIBER ACTIVITY SUMMARY
The following reports are compiled as a courtesy to help you analyze usage trends and manage your subscriber activity. Billed Usage Rate /Date Amount
Your Rate Plans gill Monthly Recurring Access Charges
Bus Advantage Msg Data 900 for 11/15 12/06 65.99
Plan Services Premium Data $10 add -on charge for 11 /15 -12/06 7.33
Sprint Mobile Hotspot Phone as Modem
Premium Data $10 add -on Other Services Change 12/01/11 -15.00
International Calls Enabled International Caflin
Other Services Cha 12/01/11 -1 .67
charge America Roaming Included
SMS Text Messages Total Monthly Recurring Access Charges $56.65
Long Distance While Roaming You are charged on a pro -rated basis when you sign up for service, or when you add to or remove units from a rate plan.
Mobile TV Lill Service Discounts
Sprint 4G Data Services
Sprint 3G Data Services Bus iness Discount Sprint 25
Dom Roaming Packet Data Kbs Total Service Discounts $12.75
Video Mail
d... Sprint Surcharges
VoiceMail Included Enhanced VoicelVail
Required Features with Plan Federal Univ Sery Assess Non -LD 3.750% 0.78
Everything Data Share 1500 Call Detail State -Univ Sery Assessment 0.300 0.06
Caller iD St ate -Gross R ece ip t s R 1 .400% 0.31
Domestic LD Rate $0 Total Sprint Surcharges $1 .15
An ime Minutes
'Sprint Surcharges are rates we choose to collect from you to help defray costs imposed on us. Surcharges are not taxes or
Unlimited Nights &Weekends -7pm Modified Nights and Weekends amounts we are required to collect from you bylaw Surcharges may include: Federal USF, regulatory charges,
Cellular Minutes administrative charges, gross receipts charges, and other charges incurred to recover costs associated with governmental
Unlimited Any Mobile, Anytime Any Mobile Anytime programs. The amounts, and the components used to calculate Surcharge amounts, are subject to change.
Subscriber Usage Summary Total Charges:for CAI3QLSGHLElF $4 a
Shard Services Plan Everything Data
Usage D) Usage Type Included Used Billed A dd
Chages SUBSCRIBER INFORMATIONAL REPORTS
LTD1007 Anytime Minutes Shared 156 0 Shared
Any Mobile, Anytime Unlimited 503 The following reports are compiled as a courtesy to help you analyze usage trends and manage your subscriber activity.
Text Unlimited 604
Nighi Weekend Unlimited 155 Subscriber Usage Summary
Picture Marl Unlimited 37
Sprint 3G Data Unlimited 548,536 Pooled Services Plan Bus Advantage Mag Data 900
Sprint 3G Data Roaming Unlimited 28,530 Usage Additional
Sprint 4G Data Unlimited 0 ID Usage Type j Included Used Billed Charges
Total Additional Charges $0.00
XD11 Anytime Minutes 11/15 12101 900 0 0 Pooled
To view total charges and usage, please go to the Account Level Usage Summary. To view your phone additional charges, please Any Mobile, Anytime 1 1115. 12!01 Unlimited 0
go to the Subscriber Activity Summary for this phone. Text 11 /I 5 12101 Unlimited 0
Dates next to a Usage Type indicates a price plan change. Night Weekend 11/15 12J01 Unlimited 0
Picture Mail 1 1115 12101 Unlimited 1
Sprint 3G Data 1 1115 12101 Unlimited 0
Sprint 3G Data Roaming 1 111 5 12101 Unlimited 0
Sprint 4G Data 1 111 5 12101 I Unlimited o
Total Additional Charges 1 $0.00
To view total charges and usage, please go to the Account Level Usage Summary. To view your phone additional charges, please
go to the Subscriber Activity Summary for this phone.
Dates next to a Usage Type indicates a priceplan change.
917788/8 11111111111 IIlf IIIII IIIIIIIIII
Account Number Billing Period Page t
YOUR SPRINT INVOICE Account 11 voice /06/11 In of
Account Name Invoice Date Invoice
Number Sprint'
t"���
CITY OF CARMEL COUNCIL December 10, 2011 148239816 -048
31 :4;95= 2811,:S1lE FINKAM
SUBSCRIBER ACTIVITY SUMMARY
Billed Usage Rate /Date Amount
Monthly Recurring Access Charges
Bus Advantage Msg Data 900 for 11/15 -12/06 65.99
Premium Data $10 add -on charge for 11/15 12106 7.33
Other Services Change 12/01111 -15.00
Other Services Change 1210 -1 .6
Total Monthly Recurring Access Charges $56.65
You are charged on a pro -rated basis when you sign up for service, or when you add to or remove units from a rate plan.
Service discounts
Busine Discount Sprint 25% -12.75
Total Service Discounts $12,75
Sprint Surcharges
Federal -Univ Sery Assess Non -LD 3.750 0.78
State -Univ Sery Assessment 0.300% 0.06
State -Gross Receipts Recovery 1 .400 0.31
Total Sprint Surcharges $1 .15
'Sprint Surcharges are rates we choose to collect from you to help defray costs imposed on us. Surcharges are not taxes or
amounts we are required to collect from you by iaw- Surcharges may inofude: Federal USF, regulatory charges,
administrative charges, gross receipts charges, and other charges incurred to recover costs associated with governmental
programs. The amounts, and the components used to calculate Surcharge amounts, are subject to change.
Total Charges fSUE F1NKAf $45 Q
SUBSCRIBER INFORMATIONAL REPORTS
The following reports are compiled as a courtesy to help you analyze usage trends and manage your subscriber activity.
Subscriber Usage Summary
Pooled Services Plan Bus Advantage Msg Data 900
Usage Additional
ID Usage Type Included Used Billed Charges
XDl 1 Anytime Minutes 11/15. 12101 900 0 0 Pooled
Any Mobile, Anytime 11115- 12/01 Unlimited 0
Text 1 t /15 12/01 Unlimited 0
Night Weekend 11/15 12!01 Unlimited 0
Picture Mail 1 1/1 5 12101 Unlimited 0
Sprint 3G Data 11115 12!01 Unlimited 0
Sprint 30 Data Roaming 11/15 12/01 Unlimited 0
Sprint 4G Data 1 1115 42101 Unlimited 0
Total Additional Charges $0.00
To view total charges and usage, please go to the Account Level Usage Summary. To view your phone additional charges, please
go to the Subscriber Activity Summary for this phone.
Dates next to a Usage Type indicates a price plan change.
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 �nvoice(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
I P I &X L� IN SUM OF
Coco n\x7eamn 1 �0 f 1
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice or
n- 4I bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
1 received except
g
o
Signature
Cost distribution ledger classification If Title
claim paid motor vehicle highway fund