ABC County Auditor
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Accounts Payable Voucher
WHITE COUNTY, INDIANA
Prescribed by State Board of Accounts
County Form No 17 (Rev 1996)
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service is 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
(mm-dd-yyyy)
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Invoice Date
(mm-dd-yyyy)
Invoice Number
Description (or note attached invoice(s) or bill(s))
Amount
Remove
Total $
I 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
Date
(mm-dd-yyyy)
Signature
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Title
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 5-11-10-2.
Date
(mm-dd-yyyy)
County Auditor
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FUND NUMBER AND NAME
VOUCHER NO.
WARRANT NO.
Payee Details
ON ACCOUNT OF APPROPRIATION
FOR
FUND NUMBER AND NAME
COST DISTRIBUTION LEDGER CLASSIFICATION
IF CLAIM PAID MOTOR VEHICLE HIGHWAY FUND
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Fund#
1000 Community Transition Fund
1224 Reassessment
7120 Old Wireless 911
7402 MVH Distribution Fund
8820 93.788 Indiana State Opioid Response
Account#
Account Title
Amount
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ALLOWED
Date
(mm-dd-yyyy)
IN THE SUM OF $
Submitter Details
Name
Email
Phone
Amount
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