221087 06/18/2013 a CITY OF CARMEL, INDIANA VENDOR: 364212 Page 1 of 1
` ONE CIVIC SQUARE HOOSIER SEALING CO
CHECK AMOUNT: $610.00
CARMEL, INDIANA 46032 5822 RAHKE DRIVE
« INDIANAPOLIS IN 46217 CHECK NUMBER: 221087
CHECK DATE: 6/1812013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 52913 610 . 00 OTHER EXPENSES
Hoosier Sealing Supply Co. INVOICE NO.
5822 Rahke Road INVOICE 3
bii4.�dpis, IN 46217 DATE c7
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A-NC2872-NC3872/T-3813 01-11
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
364212
HOOSIER SEALING SUPPLY CO Purchase Order No.
5822 RAHKE RD Terms
INDIANAPOLIS, IN 46217 Due Date 6/7/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/7/2013 52913 $610.00
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
Date fficer
VOUCHER # 131768 WARRANT# ALLOWED
364212 IN SUM OF $
HOOSIER SEALING SUPPLY CO
5822 RAHKE RD
INDIANAPOLIS, IN 46217
Carmel Water.Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
52913 01-6200-04 $610.00
Voucher Total $610.00
Cost distribution ledger classification if
claim paid under vehicle highway fund