223657 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 361528 Page 1 of 1
01 � ONE CIVIC SQUARE STAPLES BUSINESS ADVANTAGE CHECK AMOUNT: $1,607.89
s*®t� CARMEL, INDIANA 46032 DEPT DET
PO BOX 83689 CHECK NUMBER: 223657
CHICAGO IL 60696-3689
CHECK DATE: 8/27/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4230200 3206106546 230 . 18 OFFICE SUPPLIES
601 5023990 3206106547 492 . 62 OTHER EXPENSES
1082 4239039 3206106548 19 . 48 GENERAL PROGRAM SUPPL
1082 4239039 3206106549 84 . 74 GENERAL PROGRAM SUPPL
1082 4230200 3206106550 232 . 08 OFFICE SUPPLIES
1091 4230200 3206106551 241 . 79 OFFICE SUPPLIES
1091 4230200 3206106552 138 . 54 OFFICE SUPPLIES
1091 4230200 3206106553 39 . 96 OFFICE SUPPLIES
1701 4230200 3206820034 65 . 18 OFFICE SUPPLIES
1081 4230200 3206820036 63 . 32 OFFICE SUPPLIES
:INVOICE:;DATE CUSTOMER SUMMARY::II�IVOICE
so 875731-3- DET 1061088 8026492413
9/02/13 Net 30 Days 722.80
INVOI CE DETAIL
Staples Advantage Federal ID #:04-3390816
CITY OF CARMEL-NJPA CITY OF CARMEL
JIM SPELBRING ATTN: BONNIE LEWIS
1 CIVIC SQUARE 1 CIVIC SQUARE
CARMEL, IN 46032 DELIVER BY 4PM
CARMEL, IN 46032
Bill to Account: 1030382 Ship to Account: 1 CIVIC SQUARE
Budget Ctr: 130 - CITY COURT Invoice Number: 3206106546
P 0 Number: Release: Order: 7103777685-000-001
Ordered by: BONNIE LEWIS Job: Order Date: 8/02/13
r r Ur der m Ship m -,:, x
„ . RF
Line Item Number Descri tion _ Qt Qt ° '' Mess _. Ot Price Price
1 901360 PPR CLIP HLDR BK 1 EA 1 4.09 4.09
2 234062 XEROX 8. 5X11 COPY/PRINT CS 5 CT 5 44-72 223.60
3 885666 METAL PAPER CLIP HOLDER BLK 1 EA 1 2.49 2.49
Freight: ax - o a
Total 230`18
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DIET PO Box 83689, Chicago IL 60696-3689
0011467-0036948-0000003
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
ETA P L� s � (l�
� n»"!� 4r
Purchase Order No.
t-' T � "r ro > fX �
Terms
Ckjc,/4 &9 Lp
Date Due
Invoice Invoice Description Amount
D to Number (or note attached invoice(s) or bill(s))
3 /fir OG�i � _)LAJ010 IrG S a 3d
ep
Total C930,
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.
TA 12 LE' S Va -ALLOWED 20
T IN SUM OF $
�E � ��j�- T' o �
iLA-G
3o .1
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
3,12061065_ 2,3024 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
c� t S4qa�u--6
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund
LNVOICE::DATE CUSTOMER :: SUMMARY::INVOICE:
M1 8 03 13 DET 1061088 8026492413
PLEXSV:�:PAT TER
..
9 02 13 Net 30 Days 722.80
IIWOICE DETAIL
Staples Advantage Federal ID #:04-3390816
CITY OF CARMEL-NJPA CITY OF CARMEL
JIM SPELBRING ATTN: KERRI LOVEALL
1 CIVIC SQUARE 3450 W 131ST ST
CARMEL, IN 46032 DELIVER BY 4PM
CARMEL, IN 46074
Bill to Account: 1030382 Ship to Account: 3450 W 131ST ST
Budget Ctr: 601 - WATER DEPARTMENT Invoice Number: 3206106547
P 0 Number: Release: Order: 7103637727-000-001
Ordered by: KERRI LOVEALL Job: Order Date: 7/31/13
Order O r r_ Unit Ship _ m Extencled
Line, Item•Number Descr�i tion Qt � Qt Meas Qt Price Price;, ,
1 708147 ID ARMOR LUBRICANT SHEETS 1 PK 1 18. 13 18. 13
2 650284 POWERSHRED MS-460CS SHREDDER 2 1 EA 1 439.92 439.92
3 757389 GRNLINE SELF- INK STAMP ENTERED 1 EA 1 7. 21 7. 21
4 COS011090 STAMP.DTR MICLR MESGE.BK 1 EA 1 15. 57 15. 57
5 467951 STPLS,ACRYL, 2X55YD. 2. 2MIL 1 PK 1 11 . 79 11 .79
Freight: - ax: -00 SuIJ7,Total: ,
Total: 492.62_
Balance to follow
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DIET PO Box 83689, Chicago IL 60696-3689
0011468-0036948-0000004
VOUCHER # 132462 WARRANT # ALLOWED
361528 IN SUM OF $
STAPLES BUSINESS ADVANTAGE
DEPT DET
PO BOX 83689
CHICAGO, IL 60696
I
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
3206106547 01-6200-06 $492.62
i
14
�i
Voucher Total $492.62
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
361528
STAPLES BUSINESS ADVANTAGE Purchase Order No.
DEPT DET Terms
PO BOX 83689 Due Date 8/20/2013
CHICAGO, IL 60696
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/20/2013 3206106547 $492.62
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 5-11-1,0-1.6
Date Officer
--- - -- -� INVOICE::DATE :: CUST.OMER SIIIVIMARY:IIVVOIGE:
- f
8/03/13 DET 1061088 8026492415
AUr C�
G - J 2013 9/02/13 Net 30 Days 756 59
i
I1 W®ICEi DETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION FOREST DALE ELEMENTARY SCHOOL
PAULA SCHLEMMER ATTN: VALESKA SIMMONDS
1411 E 116TH ST 107221 LAKESHORE DR W
CARMEL, IN 46032 VALESKA SIMMONDS
CARMEL, IN 46033
Bill to Account: 1030597 Ship to Account: FORESTDALE ELEM
Budget Ctr: 1081-4-4230200 FOREST DALE ELEMENTARY Invoice Number: 3206106548
P 0 Number: E0003633 Release: Order: 116886747-000-002
Ordered by: DAWN KOEPPER Job: Order Date: 8/02/13
L i rie Al tem Mmibe „Deser i jA ion .` ,; Qt Qt :,°Maas .b Price ,",Pr ice
1 355390 PENDEFLEX DIVIDE IT UP FOLDER 1 PK 1 14.48 14.48
� _ . ..A _ - OrderP;Saze Premium:,:ar ".5.00 .�r
04R
l0 8 -10- �Z39039
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0001139-0061056-0000003
i19VOIC£>t3ATE CUSTOMER SUMMARY::IiVi/k7iCE:
<8'03 13.. DIET 1061088 8026492415
,e
9/02/13 Net 30 Days 756.59
IIWOI C DETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION FOREST DALE ELEMENTARY SCHOOL
PAULA SCHLEMMER ATTN: VALESKA SIMMONDS
1411 E 116TH ST 107221 LAKESHORE DR W
CARMEL, IN 46032 VALESKA SIMMONDS
CARMEL, IN 46033
Bill to Account: 1030597 Ship to. Account: FORESTDALE ELEM
Budget Ctr: 1081-4-4230200 FOREST DALE ELEMENTARY Invoice Number: • 3206106549
P 0 Number:- E0003633 Release: Order: 7103775014-000-001
Ordered by: DAWN KOEPPER Job: Order Date: 8/02/13
r - . ,.:.,, r. m - ip. Unit x e
-Line ` Item`Number. Description Qty. ` 'Qty= --Aeas Qty Price Price
1 752356 SHARPIE FINE 24 COUNT ASSSTD 1 PK 1 12.49 12.49
2 752369 SHARPIE ULTRA FINE 24 ASSTD 1 PK 1 21 .79 21 .79
3 167601 STPLS ARRWHD CAP ERASER PNK 12 20 DZ 20 .42 8.40
4 689370 POSTIT 4X4 SSFRMR MKTE 6PK 1 PK 1 15. 40 15.40
5 487908 TAPE STAPLES 3/4X1296 12PK 1 DZ 1 6. 44 6.44
6 483534 INVSBL TAPE 3/4X400 4PK 1 PK 1 3. 25 3.25
7 953113 SPECIAL DEAL 2/PK = 48 ASSORT. 1 PK 1 7. 24 7.24
8 810351 3TAB 14PT AST FF LTR 50CT 1 BX 1 9.73 9.73
rei ax- CXX)O OND Sub-Total:
Total 84'_`.74-
X082�o--�Z3ro3�
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to_.Staples Advantage, Dept DIET PO Box 83689, Chicago IL 60696-3689
L
0001140.0061056-0000004
1NV01£E.:DATE CUSTOMER SUMMARY INVOICE:
8/03/13 DET 1061088 8026492415
.. .
AUG - 9 Z013 9 02 13 Net 30 Days 756 59
— I
IWOICE DETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION CITY OF CARMEL
PAULA SCHLEMMER ATTN: LINDA ACOSTA
1411 E 116TH ST 1235 CENTRAL PARK DR E
CARMEL, IN 46032 DLV BEFORE 4PM
CARMEL, IN 46032
Bill to Account: 1030597 Ship to Account: 1235 CNTRL PK E
Budget Ctr: 1081-99-4230200 ESE ADMINISTRATION Invoice Number: 3206106550
P 0 Number: E0003637 Release: Order: 7103775102-000-001
Ordered by: DAWN KOEPPER Job: Order Date: 8/02/13
�„ r r €� � : , r r ni 1p` Unit
x e
"`Line„aItem,Number Descri t.1bn �. s Qt •' Qt ..' Meas Qt kPrce Pricea... `
1 575837 *5 CASE* SPLS 8.5X11 COPY 1 PK 1 184.10 184. 10
2 WAU22551 ASBR 8.5X11 REENTRY RED PPR RM 2 RM 2 9. 25 18.50
3 490944 PASTELS 8. 5X11 GOLD PAPER RM 1 RM 1 4.92 4.92
4 733092 BRIGHTS 8.5X11 DRK GRN RM 2 RM 2 12. 28 24.56
Freight- ax o a 3,
:._._ :; -_ a •" Total_:" '232.08"
/ova-99�2�0�0
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
I Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0001141-0061056-0000005
- _ 1NVOICE:DATE CUSTOMER .> SUMMARY:::INVO#CE
8/03/13 DET 1061088 8026492415
AUG
PL ASE.,..PAT�:8Y77xTER
L 0 t 13
H U G ` a� 9/02/13 Net 30 Days 756.59
Il!I V ®I CE DETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION CITY OF CARMEL
PAULA SCHLEMMER ATTN: JEANINE POTTRIDGE
1411 E 116TH ST 1235 CENTRAL PARK DR E
CARMEL, IN 46032 DLV BEFORE 4PM
CARMEL, IN 46032
Bill to Account: 1030597 Ship to Account: 1235 CNTRL PK E
Budget Ctr: 1091-4230200 MCC ADMINISTRATION Invoice Number: 3206106551
P 0 Number: #MC004439 Release: Order: 7103747013-000-001
Ordered by: JEANINE POTTRIDGE Job: Order Date: 8/02/13
a r r m i ni x
, A P.a
1
Line_ Item Number,�,' .Descri` tion h� Qty,. .Qt ., Meas Qt`: Price. Price
1 452170 THERMAL POS ROLLS - 10/PK 1 PK 1 21 .68 21.68
2 575837 *5 CASE* SPLS 8.5X11 COPY 1 PK 1 184. 10 184. 10
3 519018 STAPLES CORRECTION TAPE 10PK 1 PK 1 9.51 9.51
4 648234 STAPLES FLAT STACK STPLR-BLK 2 EA 2 13. 25 26.50
u!57TOta� 241 '79,
e Total: 241`.79`
/09/ �2�D200
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DIET PO Box 83689, Chicago IL 60696-3689
0001142-0061056-0000006
i
1�
'I INVOICE::DATE CQSTOMER <: SUMMARY INVOICE:
A U G " 9 20i3 8/03/13 DET 1061088 8026492415
.
.
_....
_
9/02/13 Net 30 Days 756.59
I1 W010E DETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION CITY OF CARMEL
PAULA SCHLEMMER ATTN: JEANINE POTTRIDGE
1411 E 116TH ST 1235 CENTRAL PARK DR E
CARMEL, IN 46032 DLV BEFORE 4PM
CARMEL, IN 46032
Bill to Account: 1030597 Ship to Account: 1235 CNTRL PK E
Budget Ctr: 1091-4230200 MCC ADMINISTRATION Invoice Number: 3206106552
P 0 Number: MC00442 Release: Order: 7103460810-000-001
Ordered by: JEANINE POTTRIDGE Job: Order Date: 7/29/13
i r r �: r Unit p x ni x
Line, Ltem:'Number #.; Descri t.�on .�, Qt Qt Meas Qt Pelee r.Pr•ice.
1 452170 THERMAL POS ROLLS ^- 101PK 1 PK 1 21. 68 21 .68
2 712452 BLACK CHINA MARKER 4 4 BX 9.99 .00
3 322320 6CT MAGNETIC DE MARKERS 1 PK 1 5.49 5.49
4 567488 EXPO LO FINE ASST 8 1 PK 1 7.88 7.88
5 648234 STAPLES FLAT STACK STPLR-BLK 1 EA 1 13. 25 13. 25
6 512685 NOTE CUBE 2X2 3PK 1 PK 1 7. 10 7. 10
7 490879 SPLS COLORS! 8.5X11 GREEN REAM 2 RM 2 10.79 21.58
8 733072 BRIGHTS 8.5X11 BLUE RM 2 RM 2 12. 28 24.56
9 491617 ASTRO 8.5X11 COSMIC ORANGE RM 2 RM 2 9. 25 18.50
10 507430 ASBR 8.5X11 TERRA GREEN PPR RM 2 RM 2 9. 25 18.50
reign ax o a
z ,t Total: .- 138.54
Balance to follow
zz�-
/09/- �23020a
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0001143-0061056-0000007
AUG�I I111VOICE-DATE . CUSTOMER' . Sl1MMARY INVOICE:
G - 9 2013 8/03/13 DET 1061088 8026492415
9/02/13 Net 30 Days 756 59
INVOICE DETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION CITY OF CARMEL
PAULA SCHLEMMER ATTN: JEANINE POTTRIDGE
1411 E 116TH ST 1235 CENTRAL PARK DR E
CARMEL, IN 46032 DLV BEFORE 4PM
CARMEL, IN 46032
Bill to Account: 1030597 Ship to Account: 1235 CNTRL PK E
Budget Ctr: 1091-4230200 MCC ADMINISTRATION Invoice Number: 3206106553
P 0 Number: MC00442 Release: Order: 7103460810-000-002
Ordered by: JEANINE POTTRIDGE Job: Order Date: 7/29/13
order...
r r. n i p n i -'Ex
,.Item Number Descr Qt 5 . "Qt".:_ Priced . Pr ice '
2 712452 BLACK CHINA MARKER 4 BX 4 9.99 39.96
Backorder of 7103460810
M�oo�422
1091- 42'0200
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0001144-0061056-0000008
INVOICE DATE CUSTOMER SUMMARY ITIUOICE
u
8/10/13 DET 1061088 8026583408
AUG 15 2013 9 09 13 Net 30 Days 63.32
BY:
IN VICE DETAIL
Staples Advantage Federal ID #:04-3390816
CARMEL CLAY PARKS AND RECREATION TOWNE MEADOW ELEMENTARY SCHOOL
PAULA SCHLEMMER ATTN: DAWN KOEPPER
1411 E 116TH ST 10850 TOWNE RD
CARMEL, IN 46032 DENEYSE SOLAZZO
CARMEL, IN 46032
Bill to Account: 1030597 Ship to Account: TOWNE MEADOW
Budget Ctr: 1081-9-4230200 TOWNE MEADOW ELEMENTARY Invoice Number: 3206820036
P 0 Number: E0003657 Release: Order: 7104130589-000-001
Ordered by: DAWN KOEPPER Job: Order Date: 8/09/13
r r 5 -n; r B/U m i p n x e
Line, .Item.Nuaiber. .." Description- „ . qty qty - .Measr qty:` Price Price
1 079511 TAPE 45013 BLACK ON WHITE 4 EA 4 15-33 63.32
rei - ax. .e,= -StAb7 Tot a l.
Total 63.32
�a 8�� �23D200
(D.Solo-zzo)
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DIET PO Box 83689, Chicago IL 60696-3689
0012996-0014378-0000003
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
361528 Staples Business Advantage Terms
Dept DET 2368
P.O. Box 83689
Chicago, IL 60696-3689
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
8/3/13 3206106548 Supplies $ 19.48
8/3/13 3206106549 Supplies $ 84.74
8/3/13 3206106550 Supplies $ 232.08
8/3/13 3206106551 Supplies $ 241.79
8/3/13 3206106552 Supplies $ 138.54
8/3/13 3206106553 Supplies $ 39.96
8/10/13 3206820036 Supplies $ 63.32
r
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 TOTAL $ 819.91
20_
Clerk-Treasurer
Voucher No. Warrant No.
361528 Staples Business Advantage Allowed 20
Dept DET 2368
P.O. Box 83689
Chicago, IL 60696-3689 In Sum of$
$ 819.91
ON ACCOUNT OF APPROPRIATION FOR
108 ESE/ 109 MCC
PO#or _ INVOICE NO. ACCT#/TITLE AMOUNT Board Mernbers
Dept#
1082-10 3206106548 4239039 $ 19.48 1 hereby certify that the attached invoice(s), or
1082-10 3206106549 4239039 $ 84.74 bill(s)is (are)true and correct and that the
1082-99 3206106550 4230200 $ 232.08 materials or services itemized thereon for
1091 3206106551 4230200 $ 241.79 which charge is made were ordered and
1091 3206106552 4230200 $ 138.54 received except
1091 3206106553 4230200 $ 39.96
1081-9 3206820036 4230200 $ 63.32
22-Aug 2013
$ 819.91 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
INVOICE DAT£ CUSTOMER SUN[MARY>1NVOICE
8/10/13 DET 1061088 8026583407
9/09/13 Net 30 Days 505. 10
1 d V 01 CE DETAIL
Staples Advantage Federal ID #:04-3390816
CITY OF CARMEL-NJPA CITY OF CARMEL
JIM SPELBRING ATTN: ANN DAVIS
1 CIVIC SQUARE 1 CIVIC SQUARE
CARMEL, IN 46032 DELIVER BY 4PM
CARMEL, IN 46032
Bill to Account: 1030382 Ship to Account: 1 CIVIC SQUARE
Budget Ctr: 140 - COMMON COUNCIL Invoice Number: 3206820034
P 0 Number: Release: Order: 7104143069-000-001
Ordered by ANN DAVIS Job: Order Date: 8/09/13
r r J a „ r m ip�. Unit _x
Line' ,I-tgnNaMr". 'Descri t.:�on 9.: , , ,'.._Qt s' Qt °. Mess Qt Pr`_ice
1 233593 INDEX CARD 3X5 WHT BLANK 50OCT 1 PK 1 1 . 74 1. 74
2 803614 SLIDING COVER EXP FILE BLK LTR 1 EA 1 10.88 10.88
3 356652 DUST-OFF 70Z. 6 PK 1 PK 1 46.52 46.52
4 535534 FILE HNG EXPAND POLY BK 535534 2 EA 2 3.02 6.04
reig ax Total,: �, ..
otal: 65.'18
Customer Service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4104 Page: 1
Make checks payable to Staples Advantage, Dept DET PO Box 83689, Chicago IL 60696-3689
0002727-0034159-0000003
Prescribed by Slate 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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
0
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
91&6 IN SUM OF $
$
ON ACCOUNT OF APPROPRIATION FOR
0-70--�t2
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
�.5 ( 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