213680 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 366267 Page 1 of 1
ONE CIVIC SQUARE ASHLEY ULBRICHT
CARMEL, INDIANA 46032 433 AUTUMN DRIVE CHECK AMOUNT: $145.00
CARMEL IN 46032 CHECK NUMBER: 213680
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4355300 145 . 00 ORGANIZATION & MEMBER
Annual Indiana Attorney Registration Payment Receipt
Thank you for submitting your payment! Please print this page for your records.
Confirmation #:15624883
Billing Information
Payment submitted:9/27/2012 4:26:37 PM
Assistant City Attorney
Ashley Ulbricht
aulbricht @carmel.in.gov
(574)250-7002
S
Carmel, IN NNW
United States
Payment Method
XXXXXXXXXXX
XXXXXXXXXXXXON
Invoice Summary
Ashley Ulbricht (26930-20)
Annual Fee .............................................. $145.00
Subtotal: $145.00
Grand Total: $145.00
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
Ashley M. Ulbricht
Purchase Order No.
433 Autumn Drive
Terms
Carmel, Indiana 46032
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10-4-12 Reimburse Ashley M. Ulbricht for monies she personally $145.00
expended expended for Annual State Bar Dues per the
attached receipt
TOTAII Total
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
.4chlAV M I Ilhrirht - IN SUM OF $
433 Autumn Drive
Carmel, Indiana 46032
$ $145.00
ON ACCOUNT OF APPROPRIATION FOR
Department of Law 1180
430-55300 Organization & Member dues
Board Members
DE INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1180 $145.00 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/ 2—
i u re
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund