205177 01/05/2012 CITY OF CARMEL, INDIANA VENDOR: 365930 Page 1 of 1
ONE CIVIC SQUARE DWIGHT FREENEY
i' CHECK AMOUNT: $10.00
CARMEL, INDIANA 46032 11121 HINTOCKS CIRCLE
CARMEL IN 46032 CHECK NUMBER: 205177
CHECK DATE: 1/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 10.00 OTHER EXPENSES
Ecp
CITY OF CARMEL ALARM PERMIT APPLICATION
{Please type or print)
Permit q
Application Date: 1 Amount Paid:
Res. Business Name:.' Wt h FP E e- n q
Address: 11 QJ 41 140& 6th C,2 1 0e Z:N 4 6 Z j Z- Phone: 317 716 93 9-3
Alarm Company: 2� P1 L Phone:3 Q �4� 3 7 1 5
Owner /Controller: j 194
Print Signature
The permit holder shall promptly notify the director of the Carmel Clay Communications Center in writing of any
change in the information contained in the permit application to:
CARMEL CLAY COMMUNICATIONS CENTER
311" Ave. NW
Carmel, Indiana 46032
317 -571 -2586
List Owners and Contact Personnel
The below listed personnel who have indicated "Y" to "Will Respond" have agreed to come to the alarm site within
thirty (30) minutes of notification and have access to the alarm site.
Will
Respond
Name Address Phone Y N
E. �1l�i �n+c- -ks CrK �s me- -I s k�032 17 -7/6 93 9 15 /V
q 11 n5e sn a� b 317 2S'0732.
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ln WeA���ele 3j 7 1
C e hn KA 30 41t �'7ql Y
3 v 6
Serial Number YJa Post QfEice lR5 UnElars'and Cetus
1944-00772 9 7. 12 rn+a a 0.
,Pay to �gerli
AW
Address
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X11 �C, '.5.
memo
IT
02008 Un,ed Stases Pos1a1 Sernce. All RgMs Rase ed z 1 1
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-SE N$IEASE Wf�HNIN6r• NGfi6�ii4BLE ONUjIN THE b.& AND POSSESSIONS
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Dwight Freeney
IN SUM OF
111 ?.1 Hintocks Circle
Carmel, IN 46032
$10.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# l Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
I hereby certify that the attached invoice(s), or
$10.00
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
Wednesday, January 04, 2012
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
r
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))
01/04/12 $10.00
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