178196 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 129401 Page 1 of 1
ONE CIVIC SQUARE MICHAEL HOLLIBAUGH CHECK AMOUNT: $38.97
CARMEL, INDIANA 46032 CARMEL IN 46032
CHECK NUMBER: 178196
CHECK DATE: 10/14/2009
DEP ARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4355100 38.97 PROMOTIONAL FUNDS
Y
1
WHt)LE
(FOODS
14598 Clay Terrace Blvd
Carmel, IN 46032 PH 317 569 -1517
PLS B GRNU 29- 11.99 F
TAX .00 B A 1- 11.99
Cash 20.00
CHANGE 8.01
TOTAL NUMBER OF likmS SO[-Ii I
9/28/09 1:19 PH 0561 03 0109 109
cashier today is JENNIFER
Rte, 117ts are required for all refunds
Refonds must be made within 30 dayb
E`I;: C!aL i Terrace Blvd
or- in a +�.(13;. PH :517-569-1517
Y 2 19 !)9 F
I..S 13 G`-� 1 49 F
1) BAL 26.98
C 26.98
k: 0701
Ao
I t'l j 'I F
0 2 3 05
Y c, i.) r I-, i iw-r today is AMANDA
Pj!,::eJ,pk ;;.rim reIWIRrMl for all refunds
Pa'und3 ble mode within 30 days
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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
09/28/09 Coffee for meetings $11.99
10/08/09 Coffee for meetings $26.98
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.
ALLOWED 20
Michael Hollibaugh
IN SUM OF
c/o' One Civic Square
Carmel, IN 46032
$38.97
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1192 43- 551.00 $11.99 1 hereby certify that the attached invoice(s), or
1192 43- 551.00 $26.98 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
Frida ,October 09, 2009
Director, CS
Ti Ue
Cost distribution ledger classification if
claim paid motor vehicle highway fund