178093 10/14/2009 +y CITY OF CARMEL, INDIANA VENDOR: 362339 Page 1 of 1
0 ONE CIVIC SQUARE CITIZENS MANAGEMENT INC
CARMEL, INDIANA 46032 PO BOX 620
CHECK AMOUNT: $8,610.45
HOWELL MI 48844 -0620 CHECK NUMBER: 178093
CHECK DATE: 10/14/2009
DEPARTMENT ACCOUNT PO N UMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 SWC0000385 8,610.45 OTHER EXPENSES
Citizens
Management Inc...
n
P,ny I he) 1 o e 1" c ,P Citizens Management Inc., I PO Box 620, Howell, MI 48844 -0620 Loss Fund Invoice
TO:
MS. SHELLY M. LINGELBAUGH
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL, IN 46032
DATE:
09/30/2009
LOSS FUND INVOICE
REFERENCE t AMOUNT DUE
SWC0000385
INITIAL DEPOSIT $25,000.00
09/30/2009 BALANCE $16,389.55
AMOUNT DUE $8,610.45
IF YOU HAVE ANY QUESTIONS REGARDING THIS BILL PLEASE CONTACT US AT: 517 540 -3186
PLEASE NOTE: WE ARE FORBIDDEN BY LAW TO ISSUE CHECKS SHOULD YOUR LOSS FUND BECOME ZERO BALANCE
n 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.
1 Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
GI v4c-ota
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.
11 M ALLOWED 20
�r7 125 b \c,nz+,�.�� 7 .k IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
J wi�.v� Sc, tis,tiJ
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
3J4 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
ignat re
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund