213639 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 366607 Page 1 of 1
0 ONE CIVIC SQUARE MS.SARA ROBERTSON RICE CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 MR.TODD RICE
5539 S450 W CHECK NUMBER: 213639
NEW PALASTINE IN 46163
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 100 . 00 OTHER EXPENSES
Prescribed by Slate 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
Purchase Order No.
_ 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
, �f� �1Jer�Sf�� rc,s �
IN SUM OF $
ON ACCOUNT OF PPROPRIATION FOR
�a--
e--FLj n �
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
/D / oa 3 9q0 /G�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
A � FSignat"ure
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund