173181 06/09/2009 CITY OF CARMEL, INDIANA VENDOR: 362339 Page 1 of 1
ONE CIVIC SQUARE CITIZENS MANAGEMENT INC CHECK AMOUNT: $8,041.97
CARMEL, INDIANA 46032 PO BOX 620
HOWELL MI 48844 -0620 CHECK NUMBER: 173181
CHECK DATE: 6/9/2009
DEPARTMENT A CCO U NT P NUMBE INVOICE NUMBER AM OUNT DESCRIPTION
302 5023990 SWC0000385 8,041.97 OTHER EXPENSES
r�
Citizen
Management I nc..
the11 �"n �'�'e(;"",p Citizens Management Inc., PO Box 620, Howell, MI 48844 -0620 LOSS Fund If1VOICe
TO:
MS. SHELLY M. LINGELBAUGH
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL, IN 46032
DATE:
05/29/2009
LOSS FUND INVOICE
REFERENCE AMOUNT DUE
F.,
INITIAL DEPOSIT $25,000.00
05/29/2009 BALANCE $16,958.03
AMOUNT DUE $8,041.97
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
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
Citizen's Management Inc Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
05/29/09 SWC 000030 LOSS Fund pu,v-r 1.01
Total $8,041.97
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 I\66 t Og WARRANT NO.
Citizen's Management Inc ALLOWED 20
IN SUM OF
R O. BOX 620
Howe Ivill 48844-0620
$8,041.97
ON ACCOUNT OF APPROPRIATION FOR
302 WORKERS COMP
Board Members
PO# or
DEPT. INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
302 WC 0000385 302 $8,041. 97 materials or services itemized thereon for
which charge is made were ordered and
received except
20
S i u r
Y Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund