205531 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 365042 Page 1 of 1
ONE CIVIC SQUARE RICHARD LEIRER
io CARMEL, INDIANA 46032 680 SMOKEY LANE CHECK AMOUNT: $75.00
CARMEL IN 46033
CHECK NUMBER: 205531
CHECK DATE: 1/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4341999 DEC'11 75.00 OTHER PROFESSIONAL FE
Carmel 0 Clay
Parks &Recreation CHECK REQUEST
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Date: January 3, 2012 JAN 0 3 2012
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Check payable to B Y'
Name: Richard Leirer CCPR BOARD MEMBER
Address: 680 Smokey Lane
City, State, Zip Carmel IN 46033
X Mail check to payee Return check to requestor
Check Amount 75.00 Date Required ASAP
Check needed for Monthly pay for meetings attended 12/19/11
1 Meeting(s) (a� $75.00 each 75.00 December 2011
To be paid from
PO (if applicable) N/A
Budget account GL 1125 -1 -01- 4341999
Budget Line Description Other Professional Fees
Invoice(s) and Purchase Order (if required) MUST be attached.
Requested by (print): Raula Schlemmer
Requested by (signature):
Approved by (signature
of Division Manager):
on this date
Form revised 7 -7 -08 Shared Administrative Forms Staff forms Check Request (rev 7 -7 -08)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
365042 Leirer, Richard Terms
680 Smokey Lane
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/3/12 Dec'11 Board meeting attendance 75.00
Total 75.00
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
Voucher No. Warrant No.
365042 Leirer, Richard Allowed 20
680 Smokey Lane
Carmel, IN 46033
In Sum of
75.00
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 Dec'11 4341999 75.00 1 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
11 -Jan 2012
Signature
75.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund