179007 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 065950 Page 1 of 1
ONE CIVIC SQUARE DIANA CORDRAY CHECK AMOUNT: $5.00
CARMEL, INDIANA 46032 11543 STONEY BAY CIRCLE
CARMEL IN 46033 -9501 CHECK NUMBER: 179007
CHECK DATE: 10128/2009
DE PARTMENT AC COUNT PO NUMBER INVO NUMBER AMOUNT DESCRI
920 4470302 5.00 TRANSFER FEES
C
PRESCRIBED BY STATE BOARD OF AJ GENERAL FORM NO. 352
RECEIPT 100626
HAMILTON COUNTY AUDITOR
FUND
NOBLESVILLE, IN, !l 20
RECEIVED FROM M M :5-' o
THE SUM OF VLP DOLLARS
100
ON ACCOUNT OF
PAID BY: CASH CHECK M. 0. AUTHORIZED SIGNATURE
T
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.
ayee
Aavw.. Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
f
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.
nn ALLOWED 20
IN SUM OF
C� ov
ON ACCOUNT OF APPROPRIATION FOR
0 �4 10-�02-
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
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
P'
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund