HomeMy WebLinkAbout230594 03/26/14 t"T CITY OF CARMEL, INDIANA VENDOR: 366169
ONE CIVIC SQUARE RYAN HOMES CHECK AMOUNT: $*****3,358.00*
f CARMEL, INDIANA 46032 3865 PRIORITY WAY S DRIVE#110 CHECK NUMBER: 230594
INDIANAPOLIS IN 46240 CHECK DATE: 03/26/14
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 REFUND 3,358.00 OTHER EXPENSES
"CUMPLETE& RETURN
�•� E UNJD REQUEST TTI-118 FOR�M 'M
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.c, Cie of Carmel
�L y Buddi g&Code Services y 1
g+ � 1 Building&x Code Services j
;,a+,,�, Ph. (317) 571-2444 Eix,(317)571-2499
One Civic Square;
Carmel, IN 4603:2 i
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PERMIT #(s): T a 0&f
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Lot:&Subdivision, or Address of Construction::
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C50-A
(If more than,one address needs to be listed Mid will not fit, please attach a printed list Alf f permits,with,
their corresponding permit#.)
Please print or type the reason for the requested refund, and.specific fee or fees
which are requested, in:the lines below: j
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TOTAL REFUND AMOUNT REQUESTED:
Applicant Signaturre� Date:
Applicant Name Printed Company Name:(Tf applic ble)
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APPLICANT ADDRESS � I
Street Address
City ST Zip T-7- .��^/. .
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Phone ## Fax #' j
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FOR OFFICE USE ONLY:
p' Tota{amount forfees that ARE.available. refund:•, 410 9. !
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p Fees that are.NOT.available for reftind:
p Refund approved by: U� \ 1�jt�t Date:
p Date.submitted for Payment: Amount Approved:
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c�yr. -7� *'COMPLETE& kETURN I
REFUND REQUEST THIS FOR�tTO:
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City of Carmel
7 uBuilding &Code Services
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Building&x Code Services
Ph. (.317) 3712.144 Fax(317) 571-2199 b
One Civic Square,
lw1)1A; _.
Carmel,1i4. 46032
PERMIT.#(s):. ...
I
Lot:&Subdivision; or Address of Construction:
(If more than one address ne&s to be listed and will not fit;please attach a printed list of al pe�rmits,with j
their corresponding permit#.) 1
Please print or type thereason for the requested refund, and specific fee or fees
which are requested, in:the lines below: _
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TOTAL REFI.ND ANIOU.NT REQUESTED:
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Applicant Signature Date
Applicant Name-Printed company Name(If applicable)
APPLICANT ADDRESS
Street Address
city. 5T Zip i
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Phone.# Fax.#' '
i
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FOR OFFICE USE ONLY:
p Total amount for fees,that ARE.available,for refund:
1 �7�,C)
Fees that are Not avail bIQ for refund:
p Refund approved by:. _ Dater---- '-�-1
p: Date submitted for-Payment:.
Amount.Approved:
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
\ - '2-5 Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
20Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
� " "" - � IN SUM OF $
1/b
$ S-? 01,/
ON ACCOU T OF APPROPRIATION FOR
&L3
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
�a399 o bill(s) is (are) true and correct and that the
G0 4e I materials or services itemized thereon for
oAOaSri which charge is made were ordered and
received except
20
Signature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund