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332442 11/21/18
,�° `+"*.� CITY OF CARMEL, INDIANA VENDOR: 372943 `� CHECKAMOUNT: $********40.00* ONE CIVIC SQUARE JAN NELSON :�. �_� CARMEL, INDIANA 46032 1208 HELFORD LANE CHECK NUMBER: 332442 9,;�%, CARMEL IN 46032 CHECK DATE: 11/21/18 ITON�� DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4358400 2000249031 40.00 REFUNDS AWARDS & INDE ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL VOUCHER NO. WARRANT NO. An invoice of bill to be properly itemized must show;kind of service,where performed,dates service rendered,by Vendor# ^n Allowed 20_ whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. Nelson, Jan �-h/LTL Payee 1208 Helford Lane Carmel, IN 46032 In Sum of$ Purchase Order# Nelson, Jan Terms $ 40.00 1208 Helford Lane Date Due Carmel, IN 46032 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO#ornvolce nvolce Description Dept# INVOICE NO. ACCT#/TITLE AMOUNT Date Number (or note attached invoice(s)or bill(s)) PO# Amount 1081-10 2000249031 4358400 $ 40.00 Board Members 11/13/18 2000249031 Refund $ 40.00 1 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 $ 40.00 Total $ 40.00 November 15,2018 1 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 Cost distribution ledger classification if 'PAOAthwu claim paid motor vehicle highway fund Signature -,20_ Accounts Payable Coordinator Clerk-Treasurer Title Receipt#2000249'.031 Page 1 of 1 . West.Clay Elementary . : V0UCher-._#200'05249.031 3495 W 1.26th.Street N`o, 1;320r1,8 10:15 AM :Carmel, IN 46032 7v . Phone; (317) 69874966 FAX: -= Email: info@tarn elclayparks,com ay. . f'( 1 _ P Al FS& creor IAI NELSON NATIONAL, L MMAL-.WINNER 1208 -LFsRRID:LANE CARME , IEN,'46.03 :D AC C R—EDITED: G E N.0 Y:' : Prepared 13 ::Jessb Customer ID: 25403 Primary phones (317) 225-5397, Secondary phone: .(317) 815-66.52 wund'Summairy:. Check: ($40.00) Check # Total.Received:. ($40.00) iTiotalilt'efun ($400©3 Transactions Customer. :Description Item Unit -Qty Fee Charge )an Nelson Refund balance Refund Each 1.00 $40.00 ($40.00) 1208 Helford Lane Action- Refund Balance : balance Carmel;IN 46032 Primary phone:(317),225- 5397 Email: thenelsons22@sbcglobal.net ID:25403 Total Charges ($40,,00) Total Payments ($40-00) T1 Balance. . $0 . 10V '1.11018 ' BY: r Y https://anprod.active.dom/carmel6layDarks/servlet/ShowReceipt.sd'i?receiptheader.id=85:::. . 11/13/2018'-