175040 07/22/2009 C CITY OF CARMEL, INDIANA VENDOR: 360469 Page 1 of 1
ONE CIVIC SQUARE CONNIE MURPHY
CARMEL, INDIANA 46032 9 HENSEL CT CHECK AMOUNT: $163.17
CARMEL IN 46033
CHECK NUMBER: 175040
CHECK DATE: 7/22/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4230200 15.22 OFFICE SUPPLIES
1701 4343004 147.95 MILEAGE
CLUB MANAGER MICHAEL KANTNER
317 585 1619
Fax and Pull (3171585 -9364
INDIANAPOLIS, IN
_07/17/09 07:06 1923 8168 010 1746
X MEMBER 101 -11 *1837
THANK YOU,
KING OF GLORY LUTHERAN CH
E 749972 STRAWBERRY
907162 EXPO BOARD 15.22
SUBTOTAL
TnTA1 18.19
0 18.19
ACCOUNT
APPROVAL A 01033Z
CHANGE DUE 0.00
ITEMS SOL 2
TC# 0741 6288 4447 8854 6X74 i
III I IIIII III III I II I I III IIII II IIIIII III I I III I IIIIIIII II I I III
V �I
WE VALUE YOUR OPINION lJ
WE WANT TO KNOW ABOUT YOUR SI LOPPING
EXPERIENCE TODAY AT SAM'S CLUB
Please completes a surv abn_ ut-1_ Ada _,_r;lub visit al:
htti): //www. s urvey.Sams( ;Iub. cony
IN RETURN FOR OUR TIME YOU COULD RECEIVE.
ONE OF FIyF _cn►.r_c C i is cun_oninrn_ r_nn_nc_
You must be 18 or older and a e&I resident of the
United States to enter. No purchase necessary to win.
To enter without Iurchase and for official rules v i s it
www.en try.survey.sarn sclub.com
Sweepstakes period ends on the date shown in the
official rules. Surv•3y must be taken within TWO weeks
of today.
Esta encuesta fambibn se encuentra en espahol en la
phgina de Internet.
THANK YOU
Member's Mark: Premium quality,
exceptional value, Only at Sam's Club,
07/17/09 07:07:12
MEMBER COPY
Prescribed by State Board of Accounts General Form No. 101 (1955)
La MILEAGE CLAIM
�l�(� TO f1 V� -C-t- DR.
(Governmental Unit) 1 0
On Account of Appropriation No. for
(Office, Board, Department or Institution)
DATE FROM TO ODOMETER READING' NATURE OF BUSINESS AUTO MILES MILEAGE
20 Point Point Start Finish TRAVELED PER MILE
r' V
d
Auto License No. TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
alto ing all just credits, and that no part of the same has been paid.
Date 4
Claim No, Warrant No. I have examined the within clam and
hereby certify as follows:
IN FAVOR OF
That it is in proper form;
That it is duly authenticated as required
by law;
That it is based upon statutory authority;
That it is apparently correct
incorrect
On Account of Appropriation No. for
Disbursing Officer
O (OD
CS H
Allowed 20 (D
M
H o G
H
in the sum of (Q 0
n
(D
C (D
(D if
N ��o
C)
(B=d of Commission)
(D
0
FILED rt
Ln
cD
0 cD
o
cD
R
H
(D
r-h
s (Official Title) D
7 I O CAD
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
i-
&3,
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOfCE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1c) Z �5�o' bill(s) is (are) true and correct and that the
�j`p 3q3. M79 5 materials or services itemized thereon for
which charge is made were ordered and
received except
20
f
nature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund