214508 11/14/2012 CITY OF CARMEL, INDIANA VENDOR: 357413 Page 1 of 1
0 ONE CIVIC SQUARE MUSEUM OF MINIATURE HOUSES CHECK AMOUNT: $10,000.00
CARMEL, INDIANA 46032 THOMAS LANDSHOF,DIRECTOR
*«o� 111 E MAIN ST CHECK NUMBER: 214508
CARMEL IN 46032-1823
CHECK DATE: 11/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
504 4355101 10, 000 . 00 2012 CONTRIBUTION
I
QAINe/�
D �A
ARTS GRANT PROGRAM
AGREEMENT
This Grant Agreement (herein referred to as "Agreement") entered into by and between The City
of Carmel (the City) and The Museum Of Miniature Houses And Other Collections, Inc.
(the Grantee), is executed pursuant to the terms and conditions set forth herein. In consideration
of those mutual undertakings and covenants, the parties agree as follows:
1. That on behalf of Grantee, a not-for-profit corporation, I,
Thomas A. Landshof, an authorized representative of Grantee, am
applying for a City of Carmel ("Grantor")Arts Grant.
2. Purpose of this Grant Agreement. The purpose of this Agreement is to enable the
t o ty to award a grant of a Five n e o r and No Cents
�0 to the Grantee for the eligible costs of the project (the "Project") or
services as described in Exhibits A and B of this Agreement. The funds shall be used
exclusively in accordance with the provisions contained in this Agreement.
3. Design and Implementation of Project. The Grantee agrees to use any and all grant
funds in accordance with the proposal contained within this agreement and any
documents attached to this Agreement, which are incorporated by reference.
4. Warranty of non-profit status. Grantee hereby represents and warrants that it is a
not-for-profit entity with a determination letter from the Internal Revenue Service
declaring that it is exempt from Federal income tax.
5. Payment of Grant Funds by the City. The payment of this Grant by the City to the
Grantee shall be made in accordance with the following conditions:
A. This Agreement must be fully executed and signed by both Grantee and Grantor.
B. Grantee has attached all the following information, which it represents and warrants
to be true and accurate, all which have been incorporated fully by reference:
1. A description of the proposed use of the grant funds (EXHIBIT A);
2. A budget for the calendar or fiscal year for which the grant is requested
(EXHIBIT B);
3. Certified copies of incorporation as a not-for-profit corporation under state law
(EXHIBIT C);
4. A not-for-profit application or determination letter from the U.S. Internal Revenue
Service identifying that it is a not-for-profit corporation that is exempt from
Federal income tax (EXHIBIT D);
5. Any audits, reviews or compilations available describing the financial condition
of the Grantee (EXHIBIT E);
6. A list of the Grantee's board of directors and officers listed (EXHIBIT F).
C. Any other grant conditions that City requires to be met by Grantee, specifically:
6. Grantor's right to request audit or review. Grantee shall submit to an audit or
review by an independent Certified Public Accountant of funds at the City's request,
and shall make all books, accounting records and other documents available at all
reasonable times during the term of this Grant Agreement, and for a period of three
(3) years after final payment of funds under this Agreement, for the purpose of an
audit by the City of Carmel, the State of Indiana, or their designees.
7. Year end review. Grantee agrees to provide the City of Carmel a year-end report for
each year, describing how the grant was used and the impact of the dollars received.
This Grant award may not exceed one third (1/3) of Grantee's combined contributed
income, revenue of sales, and/or ticket revenue from the previous year. If the Grant
amount is in excess of sixty thousand dollars ($60,000.00), the Grantee agrees to
provide, at Grantee's cost, a review or audit of the grantee. Said review or audit shall
be performed by a Certified Public Accountant ("CPA") who is neither an employee
of Grantee nor a member of the Grantee's Board of Directors, to be provided to the
City of Carmel by March 31 of the following year.
2
8. Funding Credit. Grantee agrees to credit the City of Carmel in the printed materials
associated with a funded program or project. The City of Carmel will supply Grantee
with the graphics/logos necessary for compliance.
9. Statutory Authority of Grantee. The Grantee expressly represents and warrants to
the State that it is statutorily eligible to receive these monies and it expressly agrees to
repay all monies paid to it under this Grant, should a legal determination of its
ineligibility be made by any Court of competent jurisdiction.
10. Use of Grant Funds by Grantee. The funds received by the Grantee pursuant to this
Agreement shall be used only to implement the Project or provide the services in
conformance with the Budget and for no other purpose. If it is determined by the
City that misappropriation of funds have occurred, the Grantee must return all funds
received by Grantor and individuals who misuse Grant funds may also be subject to
civil and/or criminal liability under Indiana or Federal law.
11. Employment Eligibility Verification. The Grantee affirms under the penalties of
perjury that he/she/it does not knowingly employ an unauthorized alien.
The Grantee affirms under the penalties of perjury that he/she/it has enrolled and is
participating in the E-Verify program as defined in IC 22-5-1-7.3. The Grantee agrees
to provide documentation to the City that he/she/it has enrolled and is participating in
the E-Verify program. Additionally, the Grantee is not required to participate if the
Grantee is self employed and does not employ any employees.
The City may terminate for default if the Grantee fails to cure a breach of this
provision no later than thirty (30) days after being notified by the State.
12. Governing Law; Lawsuits. This Agreement is to be construed in accordance with
and governed by the laws of the State of Indiana, except for its conflict of laws
provisions. The parties agree that, in the event a lawsuit is filed hereunder, they
waive their right to a jury trial, agree to file any such lawsuit in an appropriate court
in Hamilton County, Indiana only, and agree that such court is the appropriate venue
for and has jurisdiction over same.
13. Relationship of Parties. The relationship of the parties hereto shall be as provided
for in this Agreement, and neither Grantee nor any of its officers, employees,
contractors, subcontractors and/or agents are employees of City. The Grant amount
set forth herein shall be the full and maximum compensation and monies required of
City to be paid to Grantee under or pursuant to his Agreement.
14. Severability. If any term of this Agreement is invalid or unenforceable under any
statute, regulation, ordinance, executive order or other rule of law, such term shall be
3
deemed reformed or deleted, but only to the extent necessary to comply with same,
and the remaining provision of this Agreement shall remain in full force and effect.
15. Entire Agreement. This Agreement, together with any exhibits attached hereto or
referenced herein, constitutes the entire agreement between Grantee and City with
respect to the subject matter hereof, and supersedes all prior oral or written
representations and agreements regarding same. Notwithstanding any other term or
condition set forth herein, but subject to paragraph 15 hereof, to the extent any term
or condition contained in any exhibit attached to this Agreement or in any document
referenced herein conflicts with any term or condition contained in this Agreement,
the term or condition contained in this Agreement shall govern and prevail. This
Agreement may only be modified by written amendment executed by both parties
hereto, or their successors in interest.
IN WITNESS WHEROF, the parties hereto have made and executed this Agreement as follows:
The Museum Of Miniature houses And Other Collections,Inc. ("Grantee")
By: Q
Printed Name of Officer: Thomas A. Landshof
Title: Director Date: D la
CITY OF CARMEL ("Grantor")
By:
James Brainard, Mayor
Date:,/
ATTEST:
Date: 11 — u —
If you have any question concerning the City of Carmel's 2012 Arts Grant Program,grant writing,guidelines or application materials,contact:
Sharon Kibbe,City of Carmel,One Civic Square,Carmel,IN 46032,Phone:317-571-2483,skibbe a,carmel.in.aov.
4
1\/ILJSEU OF
MNLACIURE
HOUSES
A-ND OTI`IFR
COLLECTIONS INC.
Carmel City Arts Grant Program
Grant Request 2012
Intended Use of Funds
March 29, 2012
Display Window on Main Street
Display backgrounds $4100
Replace Ceiling Tiles over 45 years old $7200
Exhibits
Replace wall display Room 5 $6600
Installation & Electrical $1200
Audio Tour System
Script Maintenance $900
Storage
Shelving $400
Improve lighting $300
Improve lighting for museum shop $900
Children's educational programs
Summer intern $2300
Program materials $1200
Replace vacuum $400
Total Requested $25,500
Co-Founders:
Suzanne L. k1ofPeit o Suzanne H.Landshof e Nancy E. Lesh
1 I 1 East Main Street Carmel, Indiana 46032-1823 317.575.9466
ww��,.museumolminiatures.ore
THE—
MUSEUMOF
NUNIATURE
HOUSES
AND OTHER ; ` !I ell,
COLLECTIONS INC.
April 2, 2012
Mr. James Brainard, Mayor
City of Carmel
One Civic Square
Carmel, IN 46032
Dear Jim,
The Museum of Miniature Houses & Other Collections Inc. appreciates the opportunity to be
considered for a grant from the Carmel Arts Fund for $25,500.
The Museum of Miniature Houses has been open to the public for eighteen years attracting over
4800 visitors per year to the Carmel Arts & Design District. They have come from all 50 states
and over 13 foreign countries. The Museum is unique in that there are only five museums in the
United States that are dedicated to show and teach the art of scale miniatures. Also important to
note is that institutions like this are rare. Museums such as ours are slowly being lost. In just the
last ten years, 27 toy & doll museums have closed, and with them an important piece of
Americana. Our continued growth will be a benefit to Carmel. Patrons visit the Museum from
across the globe. A museum is always an asset to the community. It creates a sense of worth, of
value.
Because of the diversity of the Museum's collection, it appeals to all ages, both men and women,
and of course, children. Art forms include silver, porcelain, weaving, glass blowing, sculpting,
painting, fabrication, architecture and more.
Obviously when visitors come to Carmel to visit the Museum they eat in Carmel restaurants, stay
in Carmel hotels, and visit other Carmel attractions. The purpose of the Museum is many faceted.
It educates in regard to art, scale, architecture, history and imagination. Virtually every applied
art can be seen in miniature. It is a museum of fine arts in miniature.
In addition the Museum provides an educational value and a wholesome family venue to the
community. Teachers bring students, Scouts earn badges, and adults share a one-on-one
experience with a child. The museum has also drawn local and national attention and numerous
articles have appeared in local and national publications, all of which benefit the community.
Sincerely,
lio�e-7 OXAZZO
Thomas A. Landshof
Director
Co-Founders:
Suzanne L. Moffett m Suzanne H. Landshof o Nancy E. Lesh
111 East Main Street Carmel,Indiana 46032-1823 317.575.9466
www.museumofminiatures.org
4:20 PM Museum of Miniature Houses & Other Collections, Inc.
03/29/12 Profit & Loss Budget Overview
Cash Basis June-20fi2*fiTmugh'May1013
Jun '12 -May 13
Income
6000 • Donations
6010 ° Individuals 9,000.00
6011 • Box 400.00
6015 • Memberships 8,700.00
6017 • Scouts 300.00
Total 6000 • Donations 18,400.00
6020 ° Grants and Honors 5,000.00
6025 • Admissions o 9,200.00
6028 • Dividends and Interest Income 500.00
6030 • Miscellaneous Income 500.00
6032 • Workshops 750.00
6035 • Shop Sales 12,700.00
6040 • Endowment 5,000.00
6044 ° Attic Sale 2,000.00
6045 • Show Income 8,500.00
Total Income 62,550.00
Expense
6560 ° Payroll Expenses 19,200.00
7010 ° Shop Stock 3,600.00
7020 ° Postage 1,675.00
7030 • Printing and Stationary 500.00
7040 • Supplies 1,600.00
7044 • Attic sale exp 300.00
7045 ° Show Expense 4,100.00
7050 • Fees, Dues and Subscriptions 400.00
7060 • Museum Publications 1,600.00
7070 • Miscellaneous Expenses 120.00
7075 ° Sales Tax 600.00
7080 ° Advertising and Promotion 2,800.00
7095 • Insurance 860.00
7100 • Rent 13,000.00
7120 • Gas 720.00
7121 ° Water 240.00
7122 • Electricity 2,400.00
7123 ° Security 360.00
7180 • Telephone&Computer 2,160.00
7200 • Building Maintenance/Janitorial 600.00
7700 • Professional Services
7700.1 ° accountant/bookkeeper 1,325.00
Total 7700 ° Professional Services 11325.00
8000 - Collection Display Exp 1,440.00
8100 • Collection Acquisitions 1,800.00
8200 • Collection Repairs & Maint. 1,150.00
Total Expense 62,550.00
Net Income 0.00
Pagel
3:57 PM Museum of Miniature Houses & Other Collections, Inc.
03/28/12 Profit & Loss Budget Overview
Cash Basis June 2011 through May 2012
Jun '11 - May 12
Income
6000 - Donations
6010 - Individuals 15,000.00
6015 • Memberships 9,750.00
6017 • Scouts 500.00
Total 6000 • Donations 25,250.00
6020 - Grants and Honors 5,000.00
6025 - Admissions 9,600.00
6028 • Dividends and Interest Income 1,200.00
6030 • Miscellaneous Income 500.00
6035 • Shop Sales 14,700.00
6040 - Endowment 5,000.00
6045 - Show Income 9,500.00
Total Income 70,750.00
Expense
6560 - Payroll Expenses 20,000.00
7010 • Shop Stock 6,000.00
7020 Postage 2,200.00
7030 • Printing and Stationary 2,500.00
7040 • Supplies 1,500.00
7045 • Show Expense 3,500.00
7050 • Fees, Dues and Subscriptions 500.00
7060 Museum Publications 1,500.00
7070 • Miscellaneous Expenses 500.00
7080 • Advertising and Promotion 5,000.00
7095 • Insurance 860.00
7100 - Rent 13,000.00
7120 - Gas 1,500.00
7121 • Water 216.00
7122 • Electricity 2,484.00
7123 - Security 290.00
7180 • Telephone & Computer 2,200.00
7200 • Building Maintenance/Janitorial 1,800.00
7700 - Professional Services 1,200.00
8000 - Collection Display Exp 2,000.00
8100 - Collection Acquisitions 2,000.00
Total Expense 70,750.00
Net Income 0.00
Pagel
1"Xy;�, C
STATE OF INDIANA
OFFICE OF THE SECRETARY OF STATE
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greetings:
I,Connie Lawson, Secretary of State of Indiana, do hereby certify that I am,by virtue of the laws of the State of Indiana, the
custodian of the corporate records, and proper official to execute this certificate.
I further certify that records of this office disclose that
MUSEUM OF MINIATURE HOUSES AND OTHER COLLECTIONS,INC.
duly filed the requisite documents to commence business activities under the laws of State of Indiana on November 01, 1991,
and was in existence or authorized to transact business in the State of Indiana on March 28, 2012.
I further certify this Non-Profit Domestic Corporation has filed its most recent report required by Indiana law with the
Secretary of State, or is not yet required to file such report, and that no notice of withdrawal, dissolution or expiration has
been filed or taken place.
�••. + ��� In Witness Whereof, I have hereunto set my hand
r�; •: ® and affixed the seal of the State of Indiana at the
city of Indianapolis, this Twenty-Eighth Day of March,
2012.
M
•
♦i '1'Yy� t:'. .
e
C7 ♦e e�
e�+'•e'•••«;.,•�,;;,.«•'' �• Connie Lawson, Secretary of State
1991110031 /2012032888839
STATE OF INDIANA
OFFICE OF THE SECRETARY OF STATE
CERTIFICATE OF INCORPORATION
OF
MUSEUM OF MINIATURE HOUSES AND OTHER COLLECTIONS, INC.
I, JOSEPH H. HOGSETT, Secretary of State of Indiana, hereby certify that
Articles of Incorporation of the above corporation, have been presented to
me at my office accompanied by the fees prescribed by law; that I have
found such
Articles conform to' law; all as prescribed by the provisions of the
Indiana nonprofit Corporation Act of 1991,
as amenceO.
NOV, THEREFORE, I hereby issue to such Corporation this Certificate of
Incorporation, and further certify that its corporate existence will begin
November 01, 1991.
In Fitness Whereof, I have hereunto set my
hand and affixed the seal of the State of
Indiana, at the City of Indianapolis, this
First day of Nov e�ber , 1991
40 AX
<�- -"Lee
If A
STA S PH OGSETT, Secretary of
Ay
Deputy
1z
INUTANA Or—Lo r—1 AKT VI' J 1 A 1 C
BUSINESS SERVICES DIVISION
CORPORATIONS CERTIFIED COPIES
INDIANA SECRETARY OF STATE
BUSINESS SERVICES DIVISION
302 West Washington Street, Room E018
Indianapolis, IN 46204
http://www.sos.in.gov
March 29, 2011
Company Requested: MUSEUM OF MINIATURE HOUSES AND OTHER
COLLECTIONS, INC.
Control Number: 1991110031
Date Transaction # Pages
11/01/1991 Articles of Incorporation 14
- State of Indiana
Office of the Secretary of State
I hereby certify that this is a true and
complete copy of this 14 page
document filed in this office.
�,1 Sd•-2 f ,� �
�aDated: March 29, 2011
r` Certification Number: 2011032985007
Secretary of State
INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY
DISTRICT DIRECTOR
P. 0. BOX 2506
CINCINNATI, OH 45201
Employer Identification Number:
Date: Al u � ` DLN:35-1840276
316236098
MUSEUM OF MINATURE HOUSES AND Contact Person:
OTHER COLLECTIONS INC D. A. DOWNING
C/O SUZANNE L MOFFETT Contact Telephone Number:
111 E MAIN ST (513) 664°3957
CARMEL, IN 46032
Our Letter Dated:
January 10, 1992
Addendum Applies:
No
Dear Applicant;
This modifies our letter of the above date in which we stated that you
would be treated as an organization that is not a private foundation until the
expiration of your advance ruling period.
Your exempt status under section 501 (a) of the Internal Revenue Code as an
organization described in section 501 (c) (3) is still in effect. Based on the
information you submitted, we have determined that you are not a private
foundation within the meaning of section 509 (a) of the Code because you are an
organization of the type described in section 509 (a) (1) and 170 (b) (1) (A) (vi) .
Grantors and contributors may rely on this determination unless the
Internal Revenue Service publishes notice to the contrary. However, if you
lose your section 509 (x) (1) status, a grantor or contributor may not rely on
this determination if he or she was in part responsible for, or was aware of,
the act or failure to act, or the substantial or material change on the part of
the organization that resulted in your loss of such status, or if he or she
acquired knowledge that the Internal Revenue Service had given notice that you
would no longer be classified as a section 509 (a) (1) organization.
If we have indicated in the heading of this letter that an addendum
applies, ,the addendum enclosed is an integral part of this letter.
Because this letter could help resolve any questions about your private
foundation status, please keep it in your permanent records.
If you have any questions, please contact the person whose name and
telephone number are shown above.
Sincerely yours,
Distri.c Director
Letter 1050 (?)0/CG)
MUSEUM OF MINIATURE HOUSES
AND OTHER COLLECTIONS, INC.
CASH BASIS
FOR THE YEAR ENDED
MAY 31, 2011
FINANCIAL, STATEMENTS
MUSEUM OF MINIATURE HOUSES
AND OTHER COLLECTIONS, INC.
TABLE OF CONTENTS
Accountants' Compilation Report
Financial Statements: Page
Statement of Position - cash basis 1
Statement of Activities - cash basis 2
• F.7 Lim
Lee Ro Ford
&Associates
Accountants' Compilation Report
Board of Directors
Museum of Miniature Houses and Other Collections, Inc.
(A non-profit, tax exempt Corporation)
Carmel, Indiana
We have compiled the accompanying statement of position of Museum of Miniature Houses and
Other Collections, Inc. - cash basis as of May 31, 2011 and the related statement of activities -
cash basis for the fiscal year then ended, in accordance with Statements on Standards for
Accounting and Review Services issued by the American Institute of Certified Public
Accountants. The financial statements have been prepared on the cash basis of accounting, which
is a comprehensive basis of accounting other than generally accepted accounting principles.
A compilation is limited to presenting in the form of financial statements information that is the
representation of management. We have not audited or reviewed the accompanying financial
statements and accordingly, do not express and opinion or any other form of assurance on them.
Management has elected to omit substantially all of the disclosures and the statement of cash
flows ordinarily included in the financial statements prepared on the cash basis of accounting. If
the omitted disclosures and the statement of cash flows were included in the financial statements,
they might influence the user's conclusions about the Company's assets, liabilities, net assets,
revenues, expenses and cash flows. Accordingly, these financial statements are not designed for
those who are not informed about such matters.
September 6, 2011
12800 North Meridian Street,Suite 325,Carmel,Indiana 46032 (317)816-1100 (800)807-6019 (317)816-1111/fax
MUSEUM OF MINIATURE MOUSES
AND OTHER COLLECTIONS, INC.
Statement of Financial Position - Cash Basis
May 31, 2011
ASSETS
Endowment
Operating Fund Fund Total
Cash and cash equivalents $ 8,645 $ - $ 8,645
Investments - marketable securities 32,079 - 32,079
Investments - Legacy Fund - 109,078 109,078
40,724 109,078 149,802
Property and equipment, at cost:
Equipment and furnishings 6,516 - 6,516
Leasehold Improvements 1,683 - 1,683
8,199 - 8,199
Total Assets $ 48,923 $ 109,078 $ 158,001
LIABILITIES AND NET ASSETS
Payroll taxes withheld 136 - 136
Total Liabilities 136 - 136
Unrestricted 48,787 - 48,787
Temporarily restricted - 94,078 94,078
Permanently restricted - 15,000 15,000
Total net assets 48,787 109,078 157,865
Total Liabilities and Net Assets $ 48,923 $ 109,078 $ 158,001
See Accountants' Compilation Report
-1-
r ,
MUSEUM OF MINIATURE HOUSES
AND OTHER COLLECTIONS, INC.
Statement of Activities-Cash Basis
Year Ended May 31, 2011
Operating Endowment Total May 31,
Fund Fund 2011 2010
CASH RECEIPTS:
Donations:
Individuals $ 1,317 $ 12,915 $ 14,232 $ 21,528
Memberships 8,455 - 8,455 8,515
Corporate and organizational 508 - 508 956
Other donations - - - -
Shop Sales-net 11,558 - 11,558 17,714
Admissions 8,649 - 8,650 8,112
Show and Attic Income-net 5,181 - 5,181 5,752
Interest and dividends 850 - 850 1,206
Grants and Honors 214 - 214 14,233
Miscellaneous Income 60 - 60 -
TOTAL CASH RECEIPTS 36,792 12,915 49,708 78,016
OPERATING EXPENSES:
Shop inventory purchases 4,864 - 4,864 5,961
Payroll expense 19,116 - 19,116 18,496
Facility rent 12,109 - 12,109 12,109
Utilities 3,971 - 3,971 3,594
Advertising and promotion 1,708 - 1,708 4,865
Telephone 1,787 - 1,787 2,176
Supplies 1,813 - 1,813 1,200
Postage 1,619 - 1,619 1,489
Insurance Expense 817 - 817 813
Professional fees 1,325 865 2,190 2,550
Dues and subscriptions 465 - 465 702
Building maintenance 1,930 - 1,930 2,170
Improvements, net of reimbursement 2,527 - 2,527 154,772
Printing and stationery 308 - 308 148
Museum publications 408 - 408 718
Miscellaneous expense 335 - 335 91
Security 179 - 179 239
55,281 865 56,146 212,093
MUSEUM COLLECTION EXPENSES:
Display 3,670 - 3,670 6,333
Collection acquisitions 1,587 - 1,587 655
Repairs and maintenance 380 - 380 200
TOTAL DISBURSEMENTS 60,918 865 61,783 219,281
Net receipts over(under) expenses (24,126) 12,050 (12,075) (141,265)
Adjustment 25 (25) - -
Unrealized gain (loss)on investments 5,644 10,097 15,741 34,809
CHANGE IN NET ASSETS (18,457) 22,122 3,666 (106,456)
Net assets at beginning of year 67,243 86,956 154,199 260,655
NET ASSETS at end of year $ 48,786 $ 109,078 $ 157,865 $ 154,199
See Accountants' Compilation Report
-2-
MUSEUMOF x ,
HOUSES
AND orr IER X. � r
COLLECUONS ETC. . &a
March 29, 2012
Museum of Miniature Douses and Other Collections, Inc.
Officers & Board of Directors
Suzanne L. Moffett, President and Co-Founder
Suzanne H. Landshof, Vice President, Treasurer and Co-Founder
Sheila BeMiller, Director
Jeanne Burns, Director
Dorinda Dick, Director
Louise Hartigan, Director
Thomas Landshof, Director
Kurt Owens, Director
Marilyn Schaefer, Director
Peter Schaefer, Director
Pam Nieeum, Operations Manager, Secretary
Co-Founders:
Suzanne L.Moffett a Suzanne H. Landshof a Nancy E. Lesh
11: East Main Street Carmel, Indiana 460-12-1823 317.°75.9466
%i,Nvw.muscumcfminiatures.ora
VOUCHER NO. WARRANT NO.
ALLOWED 20
The Museum of Miniature Houses & Other Coll
IN SUM OF $
111 East Main Street
Carmel, IN 46032
$10,000.00
ON ACCOUNT OF APPROPRIATION FOR
Support For The Arts
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
504 Agreement 43-551.01 $10,000.00
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
Tu sday, November 13, 2012
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
11/14/12 Agreement $10,000.00
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