HomeMy WebLinkAbout195304 03/15/2011 CITY OF CARMEL, INDIANA VENDOR: 00351706 Page 1 of 1
ONE CIVIC SQUARE SCOTT BREWER
it CARMEL, INDIANA 46032 1828 CHANTADA LANE CHECK AMOUNT: $125.75
FT WAY IN 46816
CHECK NUMBER: 195304
CHECK DATE: 3/15/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4239002 125.75 REISSUE CK 157406
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of uarml
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Office of the
Clerk Treasurer
March 8, 2011
SCOTT BREWER
1828 CHANTADA LANE
FT WAYNE IN 46816
Dear Sir or Madam
On 3/19/2008, the City of Carmel issued check 157406 to you or your company for
payment of a reimbursement in the amount of $125.75. As of February 28, 2011, this
check was still outstanding. if you would like this check reissued, please complete the
bottom of this form and return it by mail to the address listed below, or send a PDF copy
of this form to csheeks�ar).carmel.in. or fax the completed form to 317- 571 -2410 by
March 31, 2011. After this date, the check will be voided and cannot be reissued.
If you have any questions, please contact me directly.
C
Cindy Sheeks Lk�'
Finance Manager}��
317 571 -2428 l
cshee ks(5).carmel. in. L)ov
rPf E SEC TION BEL O' \V AND RETURN
Name of person completing form:1 V-- 46 e�
Mail the replacement check to:
C{,on 7 c 14 44
W_
ONE (lVIC SQUARE :AVKMEL. INDIANA 46032 1 IT/ 571.2414
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
f Payee
W "I Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
i �j
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Q5, 7� 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
Cost distribution ledger classification if
claim paid motor vehicle highway fund