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179231 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 362449 Page 1 of 1 ONE CIVIC SQUARE JUDITH HAGAN CARMEL, INDIANA 46032 10946 SPRING MILL LANE CHECK AMOUNT: $50.00 CARMEL IN 46032 CHECK NUMBER: 179231 CHECK DATE: 11/11/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4341999 50.00 OTHER PROFESSIONAL FE r r Carmel e Clay Parks &Recreation CHECK REQUEST Date: 11/3/2009 NOV 0 3 2009 Check payable to Name: Judith Hagan CCPR BOARD MEMBER Address: 10946 Spring Mill Lane City, State, Zip Carmel. IN 46032 X Mail check to payee Return check to requestor Check Amount 50.00 Date Required ASAP Check needed for Monthly pay for meetings attended 10/27/09 1 Meeting(s) $50.00 each 50.00 October/2009 To be paid from PO (if applicable) N/A Budget account GL 101 1125- 4341999 Budget Line Description Other Professional Fees Invoice(s) and Purchase Order (if required) MUST be attached. Requested by (print): Paula Schlemmer Requested by (signature): Approved by (signature of Division Manager): L' on this date 1"1 1-3 0 Form revised 7 -7 -08 Shared Administrative Forms Staff forms Check Request (rev 7 -7 -08) V ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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 362449 Hagan, Judith 10946 Spring Mill Lane Carmel, IN 46032 Invoice Invoice Description PO Amount Date Number (or note attached invoice(s) or bill(s)) 50.00 11/3109 Oct'09 Park Board meeting attendance Total 50.00 I hereby certify that the attached invoice(s), or bili(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. 362449 Hagan, Judith Allowed 20 10946 Spring Mill Lane Carmel, IN 46032 In Sum of 50.00 ON ACCOUNT OF APPROPRIATION FOR 101 -General Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1125 Oct'09 4341999 50.00 1 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 5 -Nov 2009 Signature 50.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund