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177274 09/15/2009 CITY OF CARMFL, INDIANA VENDOR: 00351351 Page 1 of 1 6 ONE CIVIC SQUARE JACOB- DIETZ, INC CHECK AMOUNT: $34.00 CARMEL, INDIANA 46032 2708 E MICHIGAN ST w, INDIANAPOLIS IN 46201 CHECK NUMBER: 177274 CHECK DATE: 9/1512009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION 1110 Y 4239099 50093 34.00 OTHER MISCELLANOUS f I R t JAC ©B nETZ, INC. Invoice PRO I LC 1 t U N S P L C I A L I S 15 2708 East Michigan Street Date Invoice Indianapolis, IN 46201 8/31/2004 50093 317- 631 -2304 Fax 317 631 -311.7 Bill To: Ship To: Carmel Police Department Carmel Police Department 3 Civic Square 3 Civic Square Carmel, IN 46032 Carmel, IN 46032 P.O. No. Work Order Terms Due Date Rep Project 8/31/2009 Carmel Police Depar... Quantity Description Rate Amount 8 Fire Extinguisher annual inspection 3.00 24.00 1 Truck charge 10.00 10.00 Subtotal $34.00 Sales Tax (0.0 $0.00 Total $34.00 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. Payee Jacob Dietz; Inc. Purchase Order No. 2708 E. Michigan Street Terms Indianapolis, IN 46201 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 8/31/09 50093 p aymnent for fire extinguisher service 34.00 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 Jac Dietz, Inc IN SUM OF 2708 E. Michigan Street Indianapolis, IN 46201 34.00 ON ACCOUNT OF APPROPRIATION FOR police general fund Board Members Pots or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 50093 390 -99 34.00 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 September 2 20 09 A�A� J Z.A Signature t If Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund