219954 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 360212 Page 1 of 1
`. ONE CIVIC SQUARE MATT WORTHLEY
` la CARMEL, INDIANA 46032 C/O CRC CHECK AMOUNT: $42.00
CHECK NUMBER: 219954
<roN co
CHECK DATE: 517/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1801 4350900 042613 42 . 00 OTHER CONT SERVICES
Hamilton County Recorder
Barr L. Clark
04/26/2013 02:24:31P Trans. 0: 000501141
Business mate: 04/25/2013 Re,_ By: PSI
2013025 913 QUIT CLAIM 02:24:31P
Subtotal: *18.00
2013025 914 AMENDIMIENT02:24:31P
Subtotal: $19.00
Receipt Total.: $37.00
Paid By Amount Ref #
Cash $40.00
MATT WORTHLEY
Cash Back -$3.00
Rcvd From: MATT WORTHLEY
Good Day Sunshine!
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.352
RECEIPT
HAMILTON COUNTY AUDITOR 2016
FUND
NOBLESVILLE, IN, _ 20
RECEIVED FROM $ A'6"
THE SUM OF DOLLARS
'n 100
ON ACCOUNT OF
PAID BY: L'IC:ASH ❑CHECK ❑M.O. UTHORIZED SIGNATURE
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Forth 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
I °l r I JE y Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
q 26-13 04 r6m tl& .. r re or ' q sere ac
W ifl 6unN flea /1 AL• ° dr
Total
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
$ 2 i
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
41YO 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
5-- CC - 203
gnature
Executive Director
Cost distribution ledger classification if Title
Carmel Redevelopment Commission
claim paid motor vehicle highway fund