209194 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 361251 Page 1 of 1
ONE CIVIC SQUARE IN.GOV CHECK AMOUNT: $95.00
CARMEL, INDIANA 46032 PO BOX 6047
a `o INDIANAPOLIS IN 46206 -6047 CHECK NUMBER: 209194
CHECK DATE: 5/22/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4355300 878196 95.00 ORGANIZATION MEMBER
DATE INVOICE NUMBER CUSTOMER AC COUNT
04/30/2012 8_78_196 152074
Previous Balance T WOO
Current Charges $95.00
Payments /GreditslDebits $0.00
o P ay This Amount T $95.00
E. Total Amount Paid R u S
y Please detach stub and mail with payment
Barbara Lamb Remit Payments ONLY to:
City of Carmel IN.GOV
Barbara Lamb PO Box 6047
One Civic Square INDIANAPOLIS, IN 46206 -6047
Carmel, IN 46032
USA
152074878196000009500
DESCRIPTION QUANTITY BILLABLE
152074_billing_user IN.gov Annual Fee 1 $95.00
CURRENT ACTIVITY 1 $95.00
Account Statement: Payment Terms: Net 25
Total Amount Due 0 -30 Days 31 -60 Days 61 -90 Days 91 -120 Days Over 120 Days
$95.00 $95.00 $0.00 $0.00 $0.00 $0.00
Please contact Customer Service at 317 233 -2010 if you have any questions regarding past due or other
invoice amounts. Accounts greater than 60 days past due may incur a finance charge of 1.5% and be
Payments should be received by the 25th to be reflected on the following invoice.
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
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/30/12 878196 $95.00
1 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.GOV
IN SUM OF
PO Box 6047
Indinapolis, IN 46206 -6047
$95.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1201 878196 43- 553.00 $95.00 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
Monday, May 21, 2012
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund