213033 09/25/2012 a *f CITY OF CARMEL, INDIANA VENDOR: 120950 Page 1 of 1
ONE CIVIC SQUARE DOUGLAS HANEY CHECK AMOUNT: $149.29
CARMEL, INDIANA 46032 C/O DEPT OF LAW
C/O DEPT OF LAW CHECK NUMBER: 213033
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4355300 15445968 149 . 29 ORGANIZATION & MEMBER
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Douglas C. Haney
dhaney @carmel.in.gov
(317)571-2472
1 Civic Square
Carmel, IN 46032
Payment Confirmation
Payment ID: 15445968
Paid Fees (Transaction processed at 9:51:25 AM EDT, 9 18 2012)
Douglas Haney(11207-49) Annual Fee $145.00
Credit Card Convenience Fee $4.29
Your credit card was billed the following amount $149.29
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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
Douglas C. Haney
Purchase Order No.
13828 Smokey Ridge Drive
Terms
Carmel, Indiana 46033
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9-18-12 15445968 Reimburse Douglas C. Haney for monies he personally $149.29
expended expended for Annual State Bar Dues per the
attached receipt
TOTAII 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
Douglas G. Haney IN SUM OF $
13828 Smokey Ridge Drive
Carmel, Indiana 46033
$ $149.29
ON ACCOUNT OF APPROPRIATION FOR
Department of Law 1180
430-55300 Organization & Member dues
Board Members
DEPT' INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1180 15445968 $149.29 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
f 20
in re
Ile
Cost distribution ledger classification if
claim paid motor vehicle highway fund