219291 04/24/2013 a CITY OF CARMEL, INDIANA VENDOR: 367095 Page 1 of 1
ONE CIVIC SQUARE DAMAGE RECOVERY UNIT
�o CARMEL, INDIANA 46032 PO BOX 842264 CHECK AMOUNT: $563.14
DALLAS TX 75284-2264
„o CHECK NUMBER: 219291
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
911 4351000 68238610 563 . 14 AUTO REPAIR & MAINTEN
3of8
2of7
LNVOICE
Date: 02/27/2013
MICHAEL HOWELL Claim#: 03594015
7101 W WASHINGTON Unit#: 7I-IYK2H
Billing Invoice#f: 68238610
INDPSL,Lei 46237
Vehicle htformation
VIN: 1FM5K7F88DGB79984
Year: 2013
Make: FORD
Model: EXPL
Item Total Cost Amount Due
Damages S512.00 $512.00
Administrative Fees S100.00 Waived
Loss of Use $51.14 $51.14
2.951 days t@ S21.67/d.,@ 90%occupancy
Diminishment of Value 551.20 Waived
Total Amount Due:$563.14*
*Remit payment in U.S.Dollars.
PAY UPON RECEIPT
ALL PAYMENTS MUST INCLUDE THIS REMITTANCE TO BE CREDITED PROPERLY!
PAYABLE TO:
DAMAGE RECOVERY UNIT Claim#: 03594015
PO BOX 842264 Unit#: 7HYK2H
DALLAS,TX 752842264 Billing Invoice#: 68238610
Toll Free#: 866-300-3239
Total Amount Due: S 563.14*
*Remit payment in U.S.Dollars.
Total Amount Remitted:S
I
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))
02/27/13 68238610 Repair to Howell leased vehicle $563.14
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
Damage Recovery Unit
IN SUM OF $
P.O. Box 842264
Dallas, TX 75284-2264
$563.14
ON ACCOUNT OF APPROPRIATION FOR
Project 2013-911 Task 2013-2
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
911 I 68238610 I 43-510.00 I $563.14 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
Wednesday, April 17, 2013
Major
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund