212556 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 00353420 Page 1 of 1
ONE CIVIC SQUARE GEORGE W DAVIS CHECK AMOUNT: $47.18
CARMEL, INDIANA 46032 3854 CORNWALLIS LANE
CARMEL IN 46032 CHECK NUMBER: 212556
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 47 . 18 GASOLINE
WELCOME TO
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Descr. qty amount
< DUPLICATE RECEIPT >
<CUSTOMER COPY>
UNLD CA #11 12.1316 47.18
SELF ® 3.889/ G
Sub Total 47.18
Tax 0.00
TOTAL 47 . 18
VIT 47.18
ODOMETER: 70896 HELL
INVOICE: 422386 AUTH C 005434
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THANKS COME AGAIN /
REG# 0004 CSH# 010 DR# 01 TRAN# 42753
09/05/12 14:12:01 ST# 2368
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
09/05/12 gasoline $47.18
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
George W. Davis
IN SUM OF $
3854 Cornwallis Lane
Carmel, IN 46032
$47.18
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1110 42-314.00 $47.18 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
Thursday, September 06, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund