211764 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 354402 Page 1 of 1
ONE CIVIC SQUARE DAVID HABOUSH
CARMEL, INDIANA 46032 1942 TROWBRIDGE HIGH STREET CHECK AMOUNT: $272.00
CARMEL IN 46032
CHECK NUMBER: 211764
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4358300 REIMB 272 . 00 OTHER FEES & LICENSES
DAVID . NAUSH 8662
MARCY M. HABOUSH
1942 TROWBRtOGE HIGH ST, 317-705-1942
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RECEIPT 1958560
SI�te'Form Form m 37384 No.35/6-01)
General Form No.352S
Approved by State Board of Accounts,2001
// Name of Unit,Agency,Board or Department
C2 ,20 1
❑ CASH -IC ECK/MONEY ORDER v
RECEIVED FROM ✓a" ' N l OD
THE SUM OF �-'DOLLARS
100
ON ACCOUNT OF ,
AUTHO ED SIG ATURE
f�jE STA7F O
-'i'S Fee Receipt
Uzi
a DEPARTMENT OF HOMELAND SECURITY
402 W.Washington St,
Indianapolis, Indiana 46204
FIRE Receipt Receipt Number
596430
Date Received Project Number Method of Payment Amount
12 JUL 2012 AE2926958 CHECK $ 272 .00
County Town
Project Name and Street Address Received by
SHANNON FISHER
Approval Signature
Architect/Engineer/Owner Address
MINNIE DOAN GAZEBO Owner Name
BRUCE KNOTT BRUCE KNOTT
2 CIVIC SQUARE Comments
CARMEL IN 46032 8662-DAVID G. HABOUSH
MARCY M. HABOUSH
Receipt Details Due Due Date
AE2926958 10, 000 or more-AE2926958 $ 272 .00 07/10/2012
Total : $ 272 . 00
rescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
,n invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
ihom, 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))
$272.00
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
Dave Haboush
IN SUM OF $
$272.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I I 43-583.00 I $272.00 1 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
AUG 13 2012
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund