211335 07/31/2012 - CITY OF CARMEL, INDIANA VENDOR: 155108 Page 1 of 1
0 ONE CIVIC SQUARE INDIANA SECTION AWWA CHECK AMOUNT: $30.00
r CARMEL, INDIANA 46032 ATTN:MARY JANE MILLER
PO BOX 534 CHECK NUMBER: 211335
NASHVILLE IN 47448
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 5707 30 . 00 OTHER EXPENSES
Invoice
Indiana Section, AWWA Date Invoice#
PO Box 534
Nashville, IN 47448 7/24/2012 5707
TELEPHONE 866-213-2796
Terms
FAX: 866-215-5966
Due on receipt
Bill To
City of Carmel
3450 W. 131st St.
Carmel, IN. 46074
( n P.O. No.
Description Amount
Backflow Prevention and Cross Connection Control, Greenfield, IN - Michelle 30.00
Breedlove
7/24/2012 E-mail to Michelle Breedlove
CREDIT CARD:Visa MC Discover American Express
# Exp.: -
NAME ON CARD: Security:
SIGNATURE Billing Zip Code:
Total $30.00
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T2010
INDIANA SECTION AWWA Purchase Order No.
ATTN MARY JANE MILLER Terms
PO BOX 534 Due Date 7/24/2012
NASHVILLE, IN 47448
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/24/2012 5707 $30.00
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
'711 ? v AD �-
Date Officer
VOUCHER # 121597 WARRANT # ALLOWED
T2010 IN SUM OF $
INDIANA SECTION AWWA
ATTN MARY JANE MILLER
PO BOX 534
NASHVILLE, IN 47448
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO # INV# ACCT# AMOUNT Audit Trail Code
5707 01-6040-05 $30.00
Voucher Total $30.00
Cost distribution ledger classification if
claim paid under vehicle highway fund