178853 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 363531 Page 1 of 1
ONE CIVIC. SQUARE FELIPE SALMERON CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 810 PAWNEE DRIVE
CARMEL IN 46032 CHECK NUMBER: 178853
CHECK DATE: 10/28/2009
DE PARTMENT ACCOUNT PO N UMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 100.00 OTHER EXPENSES
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
inn. Mrs F 2 i p -e m eJro Purchase Order No.
o A- it -Dr r a -e— Terms
Lo_ r 3 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
-D Lj ed.d- r A 51 a a in e, s ea.. r ct e- -4D
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
r4 r. s Mf Et- f A Ste- n, e r-c Y1 IN SUM OF
O 1 O 706- t.L-J 4 e Dr r u m
loo
ON ACCOUNT OF APPROPRIATION FOR
Re41,n
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
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund