177816 09/29/2009 ^q, CITY OF CARMEL, INDIANA VENDOR: 354229 Page 1 of 1
ONE CIVIC SQUARE R M D /PATTI
0 CARMEL, INDIANA 46032
P0 BOX 1167 CHECK AMOUNT: $571.00
RICHMOND IN 47375 CHECK NUMBER: 177816
CHECK DATE: 9/2912009
DEP ACCO PO NU MBER IN VOICE N AMOU DESCRIPTION
221 5023990 458048 571.00 BARRETT LAW INSURANCE
Client: Carmel Clerk Treasurers Office
j Policy #103730101 107190007 -104?912010
Travelers- Property &Casualty
458048' 10/19/2009 Installment: Crime 571.00
9 3
i
X31
PLEASE PAY WITHIN 20 ;'.DAYS OF INVOICE DATE" OR CALL IMMEDIATELY IF INVOICE IS` 571.00
INCORRECT.
Thank You
MBIAIRMD/PATTI in
r ,v
o
317.845.1547
09/21/2009
Prescribed by State Boardpf &ccounts 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
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.
w
ALLOWED 20
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
l a"g 20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund