212146 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 366505 Page 1 of 1
ONE CIVIC SQUARE RAND BROOKS
CARMEL, INDIANA 46032 1875 ARROWWOOD DRIVE CHECK AMOUNT: $100.00
CARMEL IN 46033 CHECK NUMBER: 212146
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 REIMB 100 . 00 OTHER EXPENSES
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
Purchase Order No.
Terms
v 3 3
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Z
Total
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
1� IN SUM OF $
m e-, --T Al L160 3
$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or D PT.# INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), or
IDI 5b2-3,?qC)4j104 — 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
6ku 0
;7� -
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund