HomeMy WebLinkAbout320567 01/11/18 'y' *''" CITY OF CARMEL, INDIANA VENDOR: 366545,
® z ONE CIVIC SQUARE OLD7OWN DESIGN GROUP CHECK AMOUNT: $"******931.14*
,i°' CARMEL, INDIANA 46032 1132 RANGELINE ROAD CHECK NUMBER: 320567
, �roN. CARMEL IN 46032 CHECK DATE: 01/11/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 5023990 931.14 OTHER EXPENSES
VOUCHER NO. WARRANT NO.
ALLOWED I`
I q 20
IN SUM OF $ l
( 3 2- S -D- t Vic,
C0-V-M&I ( 1r c p 2
$ 93 1 .
ON ACCOUNT OF APPROPRIATION FOR
a R Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
R50-2-3q,q 0 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
' 0
Signature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund
_..................................................... .........
,;j ofcAR;y, "COMPLETE&RETURN
A,%7;[sAsy.�Fl REFUND REQUEST THIS FORM TO:
Building&Code Services City of Carmel
N.Qx t4�R t�N` %
Ph. (317) 571-2444 Fax(317) 571-2499 Building Code Services
One Civic Square;
- Carmel, IN 146032
PERMIT #(s): l oq o Iq
Lot'&Subdivision, or Address of Construction:
(If more than one address needs to be listed and will not fit,please attach a printed list of all 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:
LIC)
3l. l
TOTAL REFUND AMOUNT REQUESTED:
l
Ap licant Signat're ` Date
VHS-+]02 1)�&�h4 aw lfa�a r
APiiatNamePcant -Printed Company Name(If aPPli le
)
APPLICANT ADDRESS: T
D
Street Address N-) �1
V 2-
ST Zip
RD Lo OSLO CEYE
Phone•# Fax#
i
r DEC 06 2017 '
FOR OFFICE USEONLY:
p Total amount for fees that ARE available for refund:
p Fees that are-NOT available for refund: 1 OO
p Refund approved,by: Im tulm&a Date:
p 'Date submitted for Payment: Amount Approved: