178015 10/13/2009 CITY OF CARMEL, INDIANA VENDOR: 360212 Page 1 of 1
ONE CIVIC SQUARE MATT WORTHLEY CHECK AMOUNT: $88.00
CARMEL, INDIANA 46032 14383 GEORGE COURT
CARMEL IN 46032 CHECK NUMBER: 178015
CHECK DATE: 10/13/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIP
902 4460893 88.00 IND DESIGN STREETSCAP
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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
Purchase Order No.
Terms
I'yl D I J '7 go 3 z Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
lC? g a "IDv o9 R e c 41 s O c °p
Total 8 8 0 0
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. A
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
s 114 g14,b1 Ncw
eo
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. QQ I hereby certify that the attached invoice(s), or
gGZ 0 309 q%o9g $U. °O 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 o g
AA
i
Ign ture
Director of perations
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund