177997 10/13/2009 r
CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $200.00
CARMEL, INDIANA 46032 P 0 Box 40925 INDIANAPOLIS IN 46082 -4910 CHECK NUMBER: 177997
CHECK DATE: 10/13/2009
DEPARTMENT ACCOUNT PO NUMBER INVOI N UMBER AMOUNT DESCRIPTION
902 4347500 704794 .100.00 GENERAL INSURANCE
X02 4347500 704815 100.00 GENERAL INSURANCE
Prgseibed 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
l�rL �roU� Purchase Order No.
Terms
s, /lJ �{G2eo- 925 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9/3- o9 Ivy 79 00
`'//30 0
Total .200-00
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
"'V-QUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
qO 92 .5
6 v 92 s
ON ACCOUNT OF APPROPRIATION FOR
2ozL2 3� 7sao
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
X02 70 /cr cz:� bill(s) is (are) true and correct and that the
70�E y3 y-7 s`o� /Uacz materials or services itemized thereon for
which charge is made were ordered and
received except
Sin ire
Director of 0 erations
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund