176288 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 362655 Page 1 of 1
0 ONE CIVIC SQUARE INTELLICORP CHECK AMOUNT: $14.45
CARMEL, INDIANA 46032 GENERAL POST OFFICE
°'�q..or7a6 PO BOX 27903 CHECK NUMBER: 176288
NEW YORK NY 10087 -7903
CHECK DATE: 8/1912009
D EPARTMENT ACC OUNT P O NUMBER INV NU AMO D
3 4358800 323175 14.45 TESTING FEES
Please Remit To:
IntelliCorp
1 General Post Office
PO Box 27903
New York NY 10087 -7903
V United States
icvre��icnrav
Fed ID 11- 3661488 INVOICE
Customer: Amount Due: 14.45 USD
CITY OF CARMEL
JIM SPELBRING
ACCOUNTS PAYABLE
HUMAN RESOURCES DEPARTMENT
ONE CIVC SQUARE
CARMEL IN 46032
United States
Invoice No: 323175
Account ID: CIT00036 Invoice Date: July 31, 2009
Page: 1 of 1
Item Description Quantity Rate Net Amount
SSNVER SSN VERIFICATION 2.00 2.25 4.50
SSNVER SSN VERIFICATION 1.00 9.95 9.95
For Billing Questions Phone: 1- 888 946 -8355 Invoice net: 14.45
Fax: 216 -450 -5301
TERMS DUE UPON RECIEPT -LATE PAYMENTS ARE SUBJECT TO SERVICE INTERRUPTION.
Invoice Total: 14.45 USD
Prescribed 'yy 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
IntelliCorp Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Nationwide sxo n r Registry, SSN Verif $14.45
Total
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 NO.
����UU�� ALLOWED 20
Intel liCorp
IN SUM OF
P.O. Box 27903
NevvYoik, NY 10087-7903
$14.45
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1201 Human Resources
Board Members
PO# or
DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
120 323175 588 $14.45naterials or services itemized thereon for
which charge is made were ordered and
received except
20
f �i ri
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund