176893 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 241254 Page 1 of 1
ONE CIVIC SQUARE PETTY CASH CHECK AMOUNT: $30.99
CARMEL, INDIANA 46032 C/0 CARMEL POLICE DEPT
C/0 CARMEL POLICE DE CHECK NUMBER: 176893
CHECK DATE: 9/2/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT D ESCRIPT IO N
1110 4358300 30.99 OTHER FEES LICENSES
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THE FRONT OF THE DOCUMENT HAS A MICRO PRINT AMOUNT BOX AND THERMOCHROMIC. ABSENCE OF THESE FEATURES WILL INDICATE A COPY. 75 MoneyGmm
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PURCHASER, SIGNER FOR DRAWER COMPRADOR, FIRMA DEL LIBRADOR
N PURCHASER, BY SIGNING YOU AGREE TO THE SERVICE CHARGE AND OTHER TERMS ON THE REVERSE SIDE
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MONEY ORDER: ADDRESS GIFT CERTIFICATE: RECIPIENT i
Payable Through ISSUER /DRAWER: O =D' '_I 4 IS
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MONEYGRAM PAYMENT SYSTEMS, INC. TO AUTHENTICATE R m m
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Anchorage, Alaska PARA AUTENTICAR RESTREGAR EL CIRCULO O V 0
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ESTE RECISO PARA SUS ARCHIVOS
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
Petty Cash Purchase Order No.
3 Civic Square Terms
Carmel, IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
8/20/09 reimburse petty cash for 2 car titles 30.99
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
Petty Cash
IN SUM OF
3 Civic Square
30.99
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 583 30.99 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
August 24 20 09
4"
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund