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Home My WebLink About169981 03/18/2009 a„ VENDOR: 362657 CITY �F CARMEL, INDIANA Page 1 of 1 ONE C ,'IC SQUARE KOMEN INDPLS RACE FOR THE CURE CHECK AMOUNT: $100.00 i• /o CARME" INDIANA 46032 1099 N MERIDIAN STREET SUITE 111 INDIANAPOLIS IN 46204 CHECK NUMBER: 169981 CHECK DATE: 3/18/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1701 4355100 100.00 DONATION I race Zlonc.Komen FUN f� C t To receive credit for prizes, you MUST submit this form for all F U 1 N D RAISING FORM t M off -line donations. Form may be photocopied for distribution. fC® p s Please collect checks, cash and company match forms, place cure. C c�IS£Ot "lE V, sari "1 IG. in an envelope and attach the completed fund raising form. Register online and create your personal fund raising page at www.komenindy.org. D nor 's Na e Amount Check 1 lf every participant collected $100, over 4 million co, 6 dollars would be raised! I U Participant's Name (First. Middle Initial, Last) Address (No post offices please) City ©0000❑❑❑❑❑❑ State 00) Zip 0 ©0® Day Phone Evening Phone 0000 Part ipant Registered (check one) Online Paper n Email r Team name (if applicable) FUND RAISING PROGRAM Seek out friends, family and co- workers to support your fund raising efforts. Collect cash, money orders i and checks, place in a sealed envelope, complete this form (please print clearly) and attach to the outside of the envelope. If your employer has a matching gift program, include the completed necessary forms along with your other donations. You may mail the packet to the address on this form (please do not mail cash) or bring to packet pickup or the Pledges and Donations tent on Race day. Check our website, www.komenindy.org to see the Total Donations 2009 Race pledge prizes that will be awarded. Individual prize eligibility will be determined based on donations received as of April 27, 2009. Mail all donations to: Komen Indianapolis Race for the Cure Donations are tax deductible to the fullest extent of 1099 N. Meridian St., Ste. 111 the law. The taxpayer ID of the Indianapolis Affiliate Indianapolis, IN 46204 is 75- 2941627. DO NOT SEND CASH X eceipts will be issued for cash donations and all FOR OFFICE USE ONLY I individual contributions of $100 or more. For contri- butions less than $100, the cancelled check will serve Amt Initials as a receipt. Date Posted Prescribed 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. 4 ayee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) _T 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 1 VOUCHER NO. WARRANT NO. I ALLOWED 20 IN SUM OF ON ACCOUNT OF APPROPRIATION FOR n*�l T R k/AJ Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. tI 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 20 Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund