180439 12/16/2009 CITY OF CARMEL, INDIANA VENDOR: 120301 Page 1 of 1
t ONE CIVIC SQUARE HAMILTON COUNTY TREASURER CHECK AMOUNT: $8,228.00
CARMEL, INDIANA 46032 C/O HAMILTON CO AUDITOR
1 HAMILTON COUNTY SQUARE CHECK NUMBER: 180439
NOBLESVILLE IN 46060
CHECK DATE: 12/1612009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 8,228.00 GOUTY COURT COSTS
PRESCRIBED BY STATE BOARD OF ACCOUNTS CITY AND TOWN FORM 217 CT (1997)
REPORT TO COUNTY AUDITOR OF COURT COSTS
COLLECTED IN CITY /TOWN COURT
To the Auditor of Hamilton County, Indiana
I, Diana L. Cordray, City Officer of the City of Carmel, Indiana, hereby certify that I have received
the following amounts of the court costs payable to the County:
For the month ending November 30, 2009.
ITEMIZATION COLLECTIONS PRIOR YEAR TO DATE
THIS PERIOD COLLECTIONS
COURT COSTS: 8228.00 107,422.00 115,650.00
TOTAL AMOUNT COLLECTED
8,228.00 1 107,422.00 1 115,650.00
Dated l� 2009.
City Fiscal Officer
NOTE Mail To:
Hamilton County Auditor
One Hamilton County Square
Noblesville, IN 46060
(Make check payable to Hamilton County Treasurer)
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
I. ACCOUNTS PAYABLE VOUCHER
>I
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
C 4 .wU�l�,� LYJ Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
S o�
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I hav
with IC 5-11-
20
VOUCHER NO. WARRANT NO.
a
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Membel
PO# or INVOICE NO. ACCT #/TITLE AMOUNT voice
DEPT. I hereby certify that the attached in(
�r
6b p l bill(s) is (are) true and correct and t hat
materials or services itemized there
which charge is made were order
received except J
�c
-T r 0
Cost distribution ledger classification if
claim paid motor vehicle highway fund