207403 03/26/2012 CITY OF CARMEL, INDIANA VENDOR: 00351326 Page 1 of 1
0 ONE CIVIC SQUARE CARMEL CLAY HISTORICAL SOCIETY CHECK AMOUNT: $200.00
i` ra CARMEL, INDIANA 46032 211 FIRST STREET SW
s� `o CARMEL IN 46032 CHECK NUMBER: 207403
CHECK DATE: 3/26/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4355100 200.00 PROMOTIONAL FUNDS
HI STORICAL SOCIEI
CHARITABLE DONATION RECEIPT
t has paid the sum of 200/ to the Carmel Clay
Historical Society, Inc. in ex hange for a limited special edition 175 year
commemorative print. Of the amount paid, $95/$195 exceeds the fair market value of
the cost of the work and therefore constitutes a charitable donation to the Carmel Clay
Historical Society, Inc.
Dated this 6 L day of LU�CL 2012.
CARMEL CLAY HISTORICAL SOCIETY, INC.
By: X��
Fred Swiff, Presi nt
Carmel Clay Historical Society
211 First Street, S.W. Carmel, IN 46032
317 846 -7117
www.carmelclayhistory.org
Board of Directors
Fred Swift, president
Jim Garretson, vice president
Judy Hagan, treasurer
Stephanie Curtis, secretary
Betty Sanford, corresponding secretary
Nancy Childs
Chuck Duke
Danny O'Malia
Jan Randall
Cathie Reamer
Matt Snyder
Karl Swain
Kathy Venable
Joan Wischmeyer
Katherine Dill, executive director
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
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.
ALLOWED 20
IN SUM OF
-N
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or
DEPT INVOICE NO. ACCT #!TITLE AMOUNT 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
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund