213102 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 366560 Page 1 of 1
ONE CIVIC SQUARE MS SHANE MILLER
` CARMEL, INDIANA 46032 203 FOREST KNOLL COURT CHECK AMOUNT: $100.00
? FISHERS IN 46037 CHECK NUMBER: 213102
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 100 . 00 GAZEBO DEPOSIT REFUND
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 /
.J�'la-Yl M i // e. r Purchase Order No.
z d 3 Fcorre_-,+ h o I/ C..f
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
//e,r IN SUM OF $
F/ 5 - f . - /y 4(063 '
ON ACCOUNT OF APPRgPRIATION FOR
61E IV -
Board Members
I
PO#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
D% 023 996 1&,D— 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
�� �,, ,Signatu`re
XT
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund