317479 10/19/2017 4y�i��yf
> ,r CITY OF CARMEL, INDIANA VENDOR: 368019
® `� ONE CIVIC SQUARE THOMAS BURRELL CHECK AMOUNT: $*******102.39*
: r4; CARMEL, INDIANA 46032 939 AINTREE PARK DR#204 CHECK NUMBER: 317479
.9M� � MAYFIELD VILLAGE OH 44143 CHECK DATE: 10/19/17
ETON G�•
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 102.39 OTHER EXPENSES
CITY OF CARMEL, INDIANA VENDOR: 368019 CHECK AMOUNT;. $ 102.39
***,
ONE CIVIC SQUARE THOMAS BURRELL
r� CARMEL, INDIANA 46032 939 AI TRVELPARK DR 204 CHECK NUMBER: 317479
CHECK DATE: 10/19/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 102.39 OTHER EXPENSES
REMITTANCE ADVICE-DETACH AND RETAIN FOR YOUR RECORDS
TO VERIFY AUTHENTICITY�SEE REVERSE
E FOR DESCRIPTION OF THE 11 SECURITY FEATURES
- •
APPROVED BY THE STATE BOARD OF ACCOUNTS FOR THE CITY OF CARMEL 2002 CHECK NO.
CITY OF CARMEL, INDIANA PAYABLE AT 71-7166 317479
ONE CIVIC SQUARE UNITED FIDELITY BANK 2863
f, g CARMEL, INDIANA 46032 EVANSVILLE,INDIANA DATE: 10/19/17
1Mi r6N�°� GENERAL ACCOUNT
AMOUNT
$*******102.39*
PAY THE SUM OF ONE HUNDRED TWO DOLLARS & 39 CENTS
THIS WARRANT IS VOID TWO(2)YEARS AFTER
DECEMBER 31 OF THE YEAR OF ISSUE
TO THOMAS. BURRELL
THE 939 AINTREE PARK DR .#204 CLERK-TREASUREK
ORDER MAYFIELD VILLAGE OH 44143
OF
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Ci o f C a r m,ven k;
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Office of the I
Clerk-Treasurer
March 15,2017
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THOMAS BURRELL
939 Aintree Park Drive#204
Mayfield Heights,OH 44143
368019
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Dear Valued Vendor,
On 03/10/2014, the City of Carmel issued check number 229762 payable to THOMAS BURRELL in the amount
of $102.39. This check was issued regarding invoice number(s)REFUND. As of the date of this letter, the j
check remains outstanding. If this check should be reissued, please complete the bottom of this letter and
return by fax to 317-571-2410, or email the completed form In a PDF to dwalthall carmel.in,gov,or mail it
to the City of Carmel,Attn: Dianne Walthall,One Civic Square,Carmel, IN 46032.. The form must be received
by April 10,2017. After this date,the check will be voided and cannot be reissued.
If you have any questions,please contact me.
Sincerely,
Dianne Walthall
Deputy Clerk—Director of Finance
Office of the Clerk-Treasurer
317-571-2414
********************COMPLETE SECTION BELOW AND RETURN**********************************
/4Name: I
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Mail check to this address: A'alkluq_: PXtt ,fix 'Jze4
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ONE CIVIC:SQUARE CARMEL,INDIANA 4603.2 317/571.2414