215214 12/04/2012 CITY OF CARMEL, INDIANA VENDOR: 366436 Page 1 of 1
ONE CIVIC SQUARE VAN AUSDALL&FERRAR FINANCIAL 1
CARMEL, INDIANA 46032 6480 EAST 75TH ST
ECK AMOUNT: $1,700.78
" .� INDIANAPOLIS IN 46250-2751 CHECK NUMBER: 215214
«ON
CHECK DATE: 12/4/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4353004 43056 1, 700 . 78 COPIER
INVOICE
Remit To
VA&F Financial Inc.
6430 E 75th Street
Indianapolis, IN 46250
317 634-2913
DATE Invoice
11/20/2012 43056
Bill To
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL, IN 46032
ATTN: CINDY SHEEKS
Lease Number: VA1853 Description: Ricoh Aficio MPS5502A $1700.78
Payment Due # 2 09/01/2012-11/30/2012
Invoice Total $ 1700.78
PLEASE CONTACT KIM.WEBB WITH ANY QUESTIONS AT 317-974-7219 OR
KWEBB(o)VANAUSDALL.COM THANK YOU!
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.
�Paaye/�eA ./� ` r
Vk '
Snw� �V� "U 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.
n In ALLOWED 20
F I yI L IN SUM OF $
$ t�
ON ACCOUNT OF APPROPRIATION FOR
Board Members
INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
� � �� ,78 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
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund