177228 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 120301 Page 1 of 1
ONE CIVIC SQUARE HAMILTON COUNTY TREASURER
CARMEL, INDIANA 46032 C/O HAMILTON CO AUDITOR CHECK AMOUNT: $9,418.00
1 HAMILTON COUNTY SQUARE CHECK. NUMBER: 177228
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NOBLESVILLE IN 46060
CHECK DATE: 9/15/2009
DEPARTMENT ACCOUNT P O NUMBER IN VOICE NUMBER AM OUNT D ESCRIPTION
1 101 5023990 9,418.00 COUNTY 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 OU 2009.
ITEMIZATION COLLECTIONS PRIOR YEAR TO DATE
THIS PERIOD COLLECTIONS
COURT COSTS: 9,418.00 76,408.00 85,826.00
TOTAL AMOUNT COLLECTED
9,418.00 76,408.00 85,826.00
Dated 1 2009.
X4
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 ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
XJIJ Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note, attached invoice(s) or bill(s))
Total
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
001A I IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I 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
00 No
20
Signature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund