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236496 08/27/14
1�or_4Ap�f J® �. CITY OF CARMEL, INDIANA VENDOR: 368600 • ONE CIVIC SQUARE MICHAEL PAYNE CHECK AMOUNT: $*****2,717.00* s ;?�; CARMEL, INDIANA 46032 12101 WIND POINTE PASS CHECK NUMBER: 236496 +M�roN�, CARMEL IN 46033 CHECK DATE: 08/27/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 4231493 102.00 REFUND 609 5023990 4231493 2,615.00 REFUND Prescribed by State Board of Accounts Form No.301 (Rev.1995) ACCOUNTS PAYABL/EE VOUQQER TO 1 ' I((4Af( A1A, 11 ADDRESS /0 lfl.�t[�{�t71LK i Pti S S 4044 Invoice Date Invoice Number Item Amount L 1,Vl- 14(Yli(�- 41-0-0 a 1 00 - 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 Mo. Day Yr. Signature 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-l.6. ild Mo. Day Yr. T Officer Title Voucher No. Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS MUNICIPAL WATER DEPT. ACCT. No. CARMEL, INDIANA /,1 I C WA yL fa,yl�l`L Favor Of I�fL)I Lui 3p0;.0—,��psS Total Amount of Voucher $ Deductions Amount of Warrant v911) I o' Month of 1�✓J ©t ti Acct. i VOUCHER RECORD No. Source of Supply Water Treatment Transmission and Dist. Customer Accounts Administrative and General nu Operation-Maintenance Lam' 01 LOA Utility Plant in Service Constr.Work in Progress Materials and Supplies d Customers Deposits Total Allowed Board of Control Filed Official Title i BOYCE FORMS•SYSTEMS 1-800-382-8702 325