224120 09/10/2013 CITY OF CARMEL, INDIANA VENDOR: 00352672 Page 1 of 1
ONE CIVIC SQUARE ADAM SCHRINER
CARMEL, INDIANA 46032 CID DOCS CHECK AMOUNT: $60.00
CIO DOCS
CHECK NUMBER: 224120
CHECK DATE: 9/1012013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4355300 60 . 00 ORGANIZATION & MEMBER
Edit - Centralized Order Entry Page 1 of 1
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Shopping Cart I Receipt
Thank you for your order.
Your Confirmation Number Is VSHPACE2CA46. You May .,.nt This Page For Your Records.
item quantity 1price Idiscount Itax Ishipping net-total
Renew?t:er'fica ier. 1.00 560.00 1$0.00 Isom 50.00 S60.00
........_..................................................................._..__...................................._........................_...__......................_.._...._........................._....................----.................-_
Billing/Shipping Information
Customer Name: Schriner Adam I Billing Name: Schriner Adam I
email: ajschriner @yahoo.com Contact.
phone: (317)571-2435
Shipping Label: Mr Adam J Schriner Billing Label: Mr Adam J Schriner
17017 Lakeville Crossing 17017 Lakeville Crossing
Westfield,IN 46074 Westfield,IN 46074
Payment Information
Payment Amount: $60.00 Net-Total: $60.00
Payment Method: N— Net-Applied: $60.00
Cardholders Name: Adam J Schriner Net-Balance: $0.00
Credit Card Number. *r...
Expiration Date: 4/06
Authorization Code: B87711
Reference Number: VSHPACE2CA46
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Qne Resource Mutt:Gp[e Green`Ratang Systems
https://ay.iccsafe.org/eweb/DynamicPage.aspx?WizardKey=d3ba3167-edb3-4c4e-965e-62... 8/30/2013
VOUCHER NO. WARRANT NO.
ALLOWED 20
Adam Schriner
IN SUM OF $
c/o One Civic Square
Carmel, IN 46032
$60.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1192 I I 43-553.00 I $60.00 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
Friday, Septem er 06._,_,201.3
Director
Title
Cost distribution ledger classification if
claim paid motor 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 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))
08/30/13 Renew Inspector Certification $60.00
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
20
Clerk-Treasurer