226610 12/03/2013 CITY OF CARMEL, INDIANA VENDOR: 359016 Page 1 of 1
ONE CIVIC SQUARE KAREN BREEDLOVE CHECK AMOUNT: $250.00
`. o CARMEL, INDIANA 46032 520 SUPER STAR CT
o� CARMEL IN 46032 CHECK NUMBER: 226610
CHECK DATE: 12/3/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 112513 250 . 00 OTHER EXPENSES
Cleaning Invoice
Week Date Fee Place
11/18/2013 125.00 Water Dist Office
11/25/2013 125.00 Water Dist Office
Please Remit to:
Michelle Breedlove
Backflow Prevention -Cross-Connection Control
Carmel Water Dist Office
3450 W 131 S` Street
Carmel, IN 46074
(317) 733-2845
Total Due: 250.00
/t7'ichelle Breedlove
0 Super Star Ct
Carmel, IN 46032
317-374-1542
VOUCHER # 133426 WARRANT # ALLOWED
T5962 IN SUM OF $
BREEDLOVE, MICHELLE
CARMEL WATER DISTRIBUTION
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
112513 01-6360-06 $250.00 1
I
Voucher Total $250.00
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
T5962
BREEDLOVE, MICHELLE Purchase Order No.
CARMEL WATER DISTRIBUTION Terms
Due Date 11/21/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/21/201, 112513 $250.00
1 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 Officer