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177576 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 360613 Page 1 of 1 ONE CIVIC SQUARE BOBBY JOHN LLC CHECK AMOUNT: $7,125.00 CARMEL, INDIANA 46032 9589 VALPARAISO CT INDIANAPOLIS IN 46268 CHECK NUMBER: 177576 CHECK DATE: 9/29/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460814 91109 7,125.00 STREET DEPT FACILITY BOBBYJOHN, LLC 9589 Valparaiso Court Indianapolis, IN 46268 317- 870 -9900 Date: September 11,2009 Property: 457 Third Avenue SW, Carmel, IN City of Carmel One Civic Square Carmel, IN 46032 RE: 457 Third Avenue SW, Carmel, IN MAKE CHECKS /MONEY ORDERS PAYABLE TO: BobbyJohn, LLC Amount Amount Date Description Amount Paid Due 10/1/2009 Rent Oct 1 Oct 31, 2009 7,125.00 7,125.00 Balance Due $7 f l o(/ Prescribed by State Board of AccSunts 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. Payee LLC Purchase Order No. Terms r /y 5�626� Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) r f 1 Total -7 w25 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. r ALLOWED 20 IN SUM OF zy ON ACCOUNT OF APPROPRIATION FOR 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 200 3 Siq4ature Director o Operations Cost distribution ledger classification if Title claim paid motor vehicle highway fund