223758 09/05/2013 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $186.20
CARMEL, INDIANA 46032 PO BOX 7229
?y;oN_a INDIANAPOLIS IN 46207 CHECK NUMBER: 223758
CHECK DATE: 9/5/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF 8/13-2 186 . 20 GOLF F & B-8/13 2
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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
n G Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
S t1
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 $
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ON ACCOUNT OF APPROPRIATION FOR
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y ' Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
'M `$I --� �� /7U (86• bill(s) is (are) true and correct and that the
materials or services itemized thereon for
X which charge is made were ordered and
received except
20
Signature
<,� Title
yR Cost distribution ledger classification if
claim paid motor vehicle highway fund