217725 02/26/2013 CITY OF CARMEL, INDIANA VENDOR: 356917 Page 1 of 1
ONE CIVIC SQUARE MELANIE LENTZ
CARMEL, INDIANA 46032 11268 FONTHILL DRIVE CHECK AMOUNT: $99.00
INDPLS IN 46236 CHECK NUMBER: 217725
CHECK DATE: 2126/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1203 4350000 99 . 00 EQUIPMENT REPAIRS & M
Feb, 20. 2013 5: 03FM Asurion No. 7006 P. 1
Asurion
1850 Midway Lane
Smyrna,TN 37167
Invoice: 91422059
Fax#. 317 844 3498
Date: 2/20/2013
ESN#: F256691456908933735
From: Asurion To: Melanie Lentz
PO Box 110656 1 Civic Sq
Nashville,TN
37222 Carmel, IN 46032-2584
P.O. Number I Date Shi d Shipped VIA ESN# TRACKING#
91422059 2/16/2013 UPS 256691456908933735 1Z1YY3751343270818
Quantity Description Amount
1 P300-2420-GXYS316BLK
Samsung GXYS316BLK Deductible Total Paid $99.00
O Black TOTAL DUE
C7This may be used as your proof of purchase. THANK YOU FOR YOUR BUSINESS!
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2/19/13 about:blank
Outstanding Transactions Account Number:####-#### GEMEMM
Cardholde r:MELANIE LENTZ
Return to Sunninary
Outstanding Authorizations
Date Time Amount MCC MCC Description Merchant Name Status
2/16/2013 3:37 PM $99.00 6300 Insurance Sales And Underwriting ASURION WIRELESS Approval
about:blank 1/1
VOUCHER NO. WARRANT NO.
ALLOWED 20
Melanie Lentz
IN SUM OF $
One Civic Square
Carmel, IN 46032
$99.00
ON ACCOUNT OF APPROPRIATION FOR
Community Relations
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1203 Receipt 43-500.00 $99.00
I hereby certify that the attached invoice(s), or
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
Sunday, February 24,2013
lw� Airk
Director, Com unity Relations/Economic Development
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))
02/16/13 Receipt $99.00
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