177191 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 363341 Page 1 of 1
ONE CIVIC SQUARE ANN DENNIS ESSEX CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 15550 SHELLBARK DRIVE
NOBLESVILLE IN 45062
CHECK NUMBER: 177191
CHECK DATE: 9115/2009
DEPAR ACCOU PO NUMBER INVOICE NUMBER AMO DES
101 5023990 100.00 GAZEBO REFUND
r
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
Y 1 S 1 4N 0 e- 'ap 01, s 5 S 23L Purchase Order No.
Terms
AJe,,61e- sv i Ile—, snf b(. Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
i
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. n
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
h /e. s U i 1 e I =A/ G Z-
J�
ON ACCOUNT OF APPROPRIATION FOR
A/
4-11
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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund