211388 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 366433 Page 1 of 1
ONE CIVIC SQUARE VIRGINIA MURRAY
CARMEL, INDIANA 46032 3675 POWER DRIVE CHECK AMOUNT: $100.00
CARMEL IN 46033 CHECK NUMBER: 211388
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 100 . 00 GAZEBO REFUND
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
L/ Purchase Order No.
Terms
-z/✓ 416 03 3 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
7 z3—i � , — a, ��� — �— z !—
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 $
ON ACCOUNT OF APPROPRIATION FOR
�E-A -
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
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund