213142 09/25/2012 a CITY OF CARMEL, INDIANA VENDOR: 354306 Page 1 of 1
ONE CIVIC SQUARE MICHAEL PITMAN
CARMEL, INDIANA 46032
CHECK NUMBER: 213142
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231400 25 . 00 GASOLINE
5r
4C
SPEEDWAY
8688979
Anderson
IN 46811-4147
TRAM# : 133397
PUm p 94
Premium, Self Serve,
6 . 252 @ $3 . 999/GAL
GAS TOTAL $25 . 88
TAX
TOTAL $25 . 98
TERM :
8858888879991 "
APPR# : 171745
SEQ# : 261947191
89/17/2912 19 :44 : 33
Cardholder agrees to
pay to issuer total
charges per the
agreement between ;:
cardholder &- i ssuer .'
VISIT US AT
WWW . SPEEDWAY . COM
CUSTOMER SERVICE
1-889-643-1948
M-F 8 : 38A-5 : 39P EST
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))
09/17/12 gasoline reimbursement $25.00
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
Michael A. Pitman
IN SUM OF $
$25.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 42-314.00 $25.00
I hereby certify that the attached invoice(s), or
I I
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
Wednesday, September 19, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund