167940 01/21/2009 CITY OF CARMEL, INDIANA VENDOR: 356885 Page 1 of 1
ONE CIVIC SQUARE CENTRAL IND CLEAN CITIES ALLNCE I CHECK AMOUNT: $300.00
CARMEL, INDIANA 46032 6283 E CENTENARY ROAD
s.,?c MOORESVILLEIN 46158
CHECK NUMBER: 167940
CHECK DATE: 1/21/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4355300 300 300.00 ORGANIZATION MEMBER
CICCA, INC: Of) fo Invoice
6283 E. Centenary Road
Mooresville, N 46158 Date Invoice
I/l/2009 300
Bill To
C ity of Carmel
Darrell Norris
One Civic Square
Carmel, IN 46032
Description Amount
CICCA Associate Partner Membership Dues 300.00
cc o
7 7 6 V 1�VOC,,77
AV
oK
Total S300.00
Federal ID#
35-2141203
Prescribed„by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
1/16/04 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
CICCA, Inc. Purchase Order No.
6283 E. Centenary Rd. Terms
Mooresville IN 46158 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/1/09 300 Annual Association Dues for 2009 300.00
Total 300.00
1 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.
1
ALLOWED 20
�S
s CICCA, Inc. IN SUM OF
G
6283_E. Centenary Rd.
Mooresville IN 45158
300.00
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayor 4355300
Organizational Membership Dues
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
300 4355300 300.00 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
20
%g atu
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund