217373 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 307600 Page 1 of 1
ONE CIVIC SQUARE TREASURER OF STATE CHECK AMOUNT: $68.00
CARMEL, INDIANA 46032 INDIANA STATE BUDGET AGENCY
200 WEST WASHINGTON STREET SUITE 2 CHECK NUMBER: 217373
INDIANAPOLIS IN 46204
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4358200 ISDT-2052 68 . 00 SPECIAL INVESTIGATION
INVOICE
Indiana Department of Toxicology
550 W. 16t'St.
Indianapolis, IN 46202
Invoice Number: ISDT-2052
Invoice Date: January 30, 2013
Vendor: Carmel Police Department
Attn: Major Dave Strong
3 Civic Square
Carmel, IN 46032
Qty Unit Item Description Unit Price Ext Price
1 ea BTR External Testing $68.00 $68.00
Case#11-2759 Thomas O'Connor
Terms: NET 30 DAYS PAY THIS AMOUNT $68.00
RETAIN THIS PORTION FOR YOUR RECORDS
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RETURN THIS PORTION WITH PAYMENT
Make Checks Payable To: Invoice Number: ISDT-2052
Treasurer of State Invoice Date January 30, 2013
Vendor: Carmel Police Department
Due Date: March 1, 2013
Amount Due: $68.00
Remit To: Indiana State Budget Agency
200 West Washington Street
Room 212
Indianapolis, IN 46204
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))
01/30/13 ISDT-2052 case#11-2759 $68.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana State Budget Agency
IN SUM OF $
200 W. Washington Street, Room 212
Indianapolis, IN 46204
$68.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 I ISDT-2052 I 43-582.00 I $68.00 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, February 07, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund