213964 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 00350140 Page 1 of 1
s 0 ONE CIVIC SQUARE INDIANA STATE POLICE
�,?a CARMEL, INDIANA 46032 100 N SENATE AVE CHECK AMOUNT: $1,536.00
o� ROOM 340-IGCN CHECK NUMBER: 213964
INDIANAPOLIS IN 46204
CHECK DATE: 10/23/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 5023990 1, 536 . 00 OTHER EXPENSES
Prescribed by State Board of Accounts CLAIM City Form No.241(Rev.1964)
A CLAIM, TO BE PROPERLY ITEMIZED MUST SHOW: KIND OF SERVICE, WF -- ----- -Y WHOM,
RATE PER DAY, NUMBER OF HOURS, RATE PER HOUR, PRICE PER FOOT, PER YARD Indiana state Police Training Fund
CITY OF CARMEL IGCN Room 340
On Account of Appropriation for TO 100 N. Senate Ave.
Address_ Indianapolis, IN 46204-2259
DATE ORDER
19 ITEMIZED CLAIM DOLLARS CTS.
NO.
10/12/12 092012 CONTINUING EDUCATION TRAINING FUND 131196, 00
DEFERRALS 1 1'40 00
t � J
It 53 `6�! 00
Pursuant to the provisions and penalties of Chapter 155. Acts of 1953.
1 hereby certify that the foregoing is just and correct, that the amount claimed is legally due after allowing all
just credits, and that no part of the same has been paid.
Date October 12, 2012 19 i Acct. Clerk III
SIGNATURE TITLE
CLAIM NO. - WARRANT NO.
IN FAVOR OF I have examined the within claim and hereby
certify as follows;
That It Is In proper form.
That It Is duly authenticated as required by law.
That It Is based upon Contract
statutory authority
correct
That It Is apparently
{ Incorrect
S •
ON ACCOUNT OF APPROPRIATION Clerk Treasurer
FOR Cr 0 _
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BOARD OF TRUSTEES o c ;
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COST DISTRIBUTION LEDGER CLASSIFICATION o
IF CLAIM PAID MOTOR VEHICLE HIGHWAY FUND N y
ACCT. ACCOUNT TITLE AMOUNT
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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.
�ND1A",1+ S A--rky !c 011AIIAJ C nd
C C/ " 3 Purchase Order No.
/ Do N• nab '
` Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
to �
T. /)UQ4T/U" T .4 /_3 �-
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.
N / •> /GE �i6 ALLOWED 20
C Dori
l00 N C�l�!/�1 tfe IN SUM OF $
h/L) I 1� -?6 W -Z J�/ q6 at)
ON ACCOUNT OF APPROPRIATION FOR
P /�-v
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Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
ZI D Cjq)ill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
B 0
1
Sign
atu
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund