219565 04/26/2013 �,q*f CITY OF CARMEL, INDIANA VENDOR: Page 1 of 1
ONE CIVIC SQUARE HAMILTON COUNTY AUDITOR
s CHECK AMOUNT: $20.00
CARMEL, INDIANA 46032
CHECK NUMBER: 219565
CHECK DATE: 4/26/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4340600 20 . 00 TRANSFER FEES
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM-NO.352
RECEIPT
HAMILTON COUNTY AUDITOR 2008
FUND
NOBLESVILLE, IN, 20. ---Y--�--�
0-
RECEIVED FROM $;a '00
THE SUM OF J DOLLARS
100
ON ACCOUNT OF
PAID BY: ]CASH L9 CHECK ❑M.O. AUTHORIZED SIGNATURE
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
V Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached ' voice(s) or bill(s))
- t' S O
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.
ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
ETA qm,
� -t
pis Board Members
PO#or INVOICE NO. ACCT##/T—IITLE 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
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund