178537 10/26/2009 CITY OF CARMEL, INDIANA VENDOR: 00351787 Page 1 of 1
j; ONE CIVIC SQUARE SHERRY S. MIELKE CHECK AMOUNT: $318.14
CARMEL, INDIANA 46032 3662 E CARMEL DRIVE
CARMEL IN 46033 CHECK NUMBER: 178537
CHECK DATE: 10126/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4359003 318.14 FESTIVAL /COMMUNITY EV
r
STATE OF INDIANA
SS:
COUNTY OF HAMILTON
AFFIDAVIT
1, Sherry Mielke, Direetor of Operation, personally expended the following sum of money for a
lunch provided to the exhibitors for Artobmobilia. My request for reimbursement is as follows:
9/12/09 318.14 from Hot Box Pizza
TOTAL ill 8.14
"Please note the delivery driver did not bring receipt at time of delivery. A request to print the
receipt was made on September 16, 2009. The re -print did not include the discount given.
Dated this 14th day of October, 2009.
Sherry S. Mielke
Subscribed and sworn to before me, the undersigned Notary Public, this 15th day of October,
2009.
My Commission Expires:
mswurd :z:lsmielkeWomis�affadivitlunch 04 24 09Ad 10 115/09]
twcount Nun-cr. SMOMWAMMMM
Page 1 of 3 10/14/09
Your Account Summary
Billing Cycle Closing Date 09 117/09
Amount Over Credit Line $0.00
Amount Past Due $0.00
Current Minimum Due $10.00 Access current and past statements
Total Minimum Due $10.00
View recent activity
Previous Balance $0.00 Pay y our bill online 24f7 with
Payments Credits $0.00 same day posting'
Purchases Debits $478.83
Other Charges $0.00 Set up email alerts
FINANCE CHARGES $0.00
Account Balance Regisfernowat
SwraCa TCl.COf11
Your Credit Summary rop m6nd l
a
Tota1 Credit Line $11,70.0.00
Available Credit Line $10,905.00
Cash Access Line $2,340.00
Available Cash $2.340.00
Activity Safe Date Post Date Description Amount
low
09/12/09 09/12109 HOTBOX PIZZA CARMEL IN 318.14
913 8517757 KS -GPM
Average Corresponding Periodic Rate Periodic
Dairy ANNUAL Do-Day FINANCE
Rates Rate varies Balance Balance PERCENTAGE RATE M--Month CHARGE
SEARS
REGULAR $O.00 $0.00 12.83 .03529 P)' $0.00
EXTERNAL
REGULAR $478.83 $0.00 12.83 .0352'Ya(D) $0.00
CASH ACCESS
REGULAR $0.00 $0.00 14.05 .0385'Yo(D)" $0.00
Days in Billing Period: 30 Effective ANNUAL PERCENTAGE RATE: N/A Minimum FINANCE CHARGE: $0.00
Please follow payment instructions on reverse side. Payment must be received by 5:00
p.m. local time on Payment Due Date.
Sears Mastercard® III II1111NIlilllllllllllllllilll 1111111
Account Number_
-i
Payment Total
Account Balance Due Date Minimum Due Amount Enclosed
10/14/09 r$
0060222 12 2348 04260 1 TX$503 FVC 001 7 N
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Make check payable to
MRS SHERRY S MIELKE SEARS CREDIT CARDS
3662 E CARMEL DR PO BOX 183082
CARMEL IN 46033 -4317 COLUMBUS, OH 43218 -3082
Please make address corrections above.
00010110 0000000 1217
THUMI
Pres$rib& 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))
y o 9 /o �y a9 �U��� 1� „may 3�5
.s
O
f
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accgrdance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
51y, 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
D /s 20 09
W 1A
S' nature
Director o Aerations
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund