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186591 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 364246 Page 1 of 1 0 ONE CIVIC SQUARE DAN PEPMIER CHECK AMOUNT: $1,268.22 4 CARMEL, INDIANA 46032 1574 ORCHARD PARK DRIVE N INDIANAPOLIS IN 46280 -1513 CHECK NUMBER: 186591 CHECK DATE: 6/15/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 1,268.22 OVERPMT REFUND Page: 1 CARMEL UTILITIES Customer Maintenance Ledger Date: 6/14/2010 2:56:31 PM User Name Ted Account Number 3451293001 Customer Name DAN PEPMIER Status Active Home Phone (317) 844 -3640 x Work Phone x Billing Type Normal Class RESIDENTIAL Billing Status Billing Cycle BOOKS 41 45 Address 1574 ORCHARD PARK DR N INDIANAPOLIS, IN 46280 -1513 Service Location <All> Listed From All Periods Description Date Amount Balance Payment 6/14/2010 (1,288.82) (1,268.22) Charge 6/3/2010 20.60 20.60 Payment 5/26/2010 (22:.09) 0.00 Charge 4/30/2010 21.99 22.09 Payment 4/27/2010 (23.77) 0.10 Charge 4/2/2010 24.77 23.87 Payment 3/15/2010 (49192) (0.90) Charge 3/3/2010 24.77 49.02 Penalty 3/2/2010 0.87 24.25 Charge 2/3/2010 23.38 23.38 Payment 1/2612010 (23.38) 0.00 Charge 1/4/2010 23.38 23.38 Payment 12/22/2009 (22.67) 0.00 Charge 12/3/2009 23.38 22.67 Payment 12/1/2009 (18.50) (0.71) Charge 11/412009 17.82 17.79 Payment 11/3/2009 (19.93) (0.03) Penalty 10/30/2009 0.72 19.90 Payment 10/6/2009 (20.49) 19.18 Charge 10/5/2009 19.21 39.67 Penalty 9/29/2009 0.76 20.46 Charge 9/2/2009 20.60 19.70 Payment 8/31/2009 (26.69) (0.90) Prescribed by State Board of Accounts Form No. 301 (Rev, 1995) ACCOUNTS PAY �LEVIGIVNJER n T ADDRESS-- 0(ZCW LJ 0 (JA1L Invoice Date Invoice Number Item Amount J 9 +011-') Tb A r t 1 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 Signature Title I hereby certify that the attached invoice(s), or bill(s), is (are) true and corn ct and I have audited same in accordance 'AJ�r I, ith IC 5-11-10-1.6. JN� ffi r Title Voucher No. Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS MUNICIPAL WATER DEPT. ANO NO. CARMEL, INDIANA �_p MaYkjot �c tea. (A Total Amount of Voucher Deductions j Amount of Warrant Month of 19 VOUCHER RECORD Acct. No. Source of Suppl Water Treatment Transmission and Dist. Customer Accounts Administrative and General Operation- Maintenance Utility Plant in Service Constr. Work in Progress Materials and Supplies Customers Deposits Totat I Allowed I Board of Control Filed Official Title BOYCE FOAMS SYSTEMS 1 -800- 382 -8702 325