213051 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP
CARMEL, INDIANA 46032 P 0 BOX 40925 CHECK AMOUNT: $50.00
INDIANAPOLIS IN 46280-5000 CHECK NUMBER: 213051
CHECK DATE: 9/2512012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
209 4347500 801567 50 . 00 GENERAL INSURANCE
Indianapolis,IN 46280-0925 P.O.Box 4925
I N V O I C E # 801567 OHYLANT
V ROUP Local:317-817-5000 --
CARME80 79 08/13/12
32S377087
W.Michael Wells _
City of Carmel 08/13/12 08/13/20 08/13/12
Steve Engelking S 50.00
One Civic Square
Carmel,IN 46032
INVOICE# 801567
08/13/12 NEW BOND 32S377087 NOTARY BOND American States Insurance Co S 50.00
NOTARY BOND FOR TONI G.BUTLER
Invoice Balance: $ 50.00
301 Pennsylvania Parkway • Suite 201 • P.O.Box 40925 •Indianapolis,IN 46280-0925
Toll Free:800-678-0361 Local:317-817-5000 •Fax:317-817-515I
40 Be
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
Hylant Group of Indianapolis
Purchase Order No.
301 Pennsylvania Parkway, Suite 201
Terms
Indianapolis, Indiana 46280-0925 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9-18-12 Notary Bond for Toni G. Butler per the attached
Application For Appointment As A Notary Public
In The State Of Indiana
Total
$50.00
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
Hylant r3roup of Indianapolis PV � oZS IN SUM OF $&Y Lfo?
Carmel, Indiana 46280 -- oqa s
$ 50.00
ON ACCOUNT OF APPROPRIATION FOR
DEFERRAL FEE FUND 209
430-47500 General Insurance
Board Members
DEEP INVOICE NO. ACCT#!TITLE AMOUNT I hereby certify that the attached invoice(s), or
209 801567 $50.00 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
20
natur
Cost distribution ledger classification if Titl
claim paid motor vehicle highway fund