214852 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 307600 Page 1 of 1
0 ONE CIVIC SQUARE TREASURER OF STATE
CARMEL, INDIANA 46032 INDIANA STATE BUDGET AGENCY CHECK AMOUNT: $650.00
200 WEST WASHINGTON STREET SUITE 2 CHECK NUMBER: 214852
INDIANAPOLIS IN 46204
CHECK DATE: 11/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351501 ISDT-1736 650 . 00 EQUIPMENT MAINT CONTR
Invoice
Indiana State Department of Toxicology
To: Carmel Police Department
3 Civic Square
Carmel, IN 46032
Invoice Number: ISDT-1736 Invoice Date: November 5, 2012
Item: 2013 Maintenance Agreement for Evidentiary Breath Test Instruments
PAY THIS AMOUNT $650.00 no later than February 28, 2013
Make check payable to: Treasurer of State
Remit to: Indiana State Budget Agency
200 W. Washington Street, Rm 212
Indianapolis, IN 46204
Retain this portion for your records
-------------------------------------------------------------------------------------------------------------------------------
Return this portion with payment
Invoice Number: ISDT-1736
Invoice Date: November 5, 2012
Customer: Carmel Police Department
Due Date: February 28, 2013
Amount Due: $650.00
VOUCHER NO. WARRANT NO.
Treasurer of State ALLOWED 20
Indiana State Budget Agency IN SUM OF $
200 W. Washington Street, Rm 212
Indianapolis, IN 46204
$650.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 I ISDT-1736 I 43-515.01 I $650.00 1 hereby certify that the attached invoice(s), or
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
Thursday, November 15, 2012
Chief of Police
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))
11/05/12 ISDT-1736 annual payment $650.00
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