211647 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 366467 Page 1 of 1
ONE CIVIC SQUARE ALAN BILTIMIER
€ 0 CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 3877E 126TH ST
CARMEL IN 46033 CHECK NUMBER: 211647
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 100 . 00 GAZEBO REFUND
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
Zo-{'1 /°5 i� i P-4 1 Purchase Order No.
03 g7 7 / Z �° ' S-t- Terms
a-r`r►'� �- _A O 3 3 Date Due
Invoice Invoice, Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total / d�
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 $
g?7 E , iz 6 f" s-t- .
C.,a,rm 33
ON ACCOUNT OF APPROPRIATION FOR
6E A/
oL
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
l0 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
,r
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund