215841 12/25/2012 as w c�\Yf CITY OF CARMEL, INDIANA VENDOR: Page 1 of 1
ONE CIVIC SQUARE ROBERT J LUNSFORD
CARMEL, INDIANA 46032 21290 SCHULLEY ROAD CHECK AMOUNT: $2,717.00
NOBLESVILLE,IN 46062-9422 CHECK NUMBER: 215841
CHECK DATE: 12/21/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 2717 . 00 NSF REIMBURSEMENT
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Account: Deposit Accounts - eneral Account-USD:074908594 -
Date to 1z?z4?z01z I_I
Reference#. 0 to
Amount: z717.oa to 717,00
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00099993427-Checking-General Account-Li 074908594
Date >'t 'I ype Description Ref a Debit Credit
12121/2012 Check 215841 2.717.00 ---
121W012 Deposit -- -- 2 717 00 ? '-1 0 VkC Z I ICt'
12117'2012 Deposit --- 2 717.00
121012012 Return RETURPI DEPOSIT ITEIA(St ADVICE 10 7114 2 717 00
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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.
Payee
l
i Yom► P L1 Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
ti �cC
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.
1 , ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I 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
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund