HomeMy WebLinkAbout167306 12/23/2008 CITY OF CARMEL, INDIANA VENDOR: T362307 Page 1 of 1
j, ONE CIVIC SQUARE GREGORY A COX
CARMEL, INDIANA 46032 13727 SMOKEY RIDGE OVERLOOK CHECK AMOUNT: $567.00
CARMEL IN 46033 CHECK NUMBER: 167306
CHECK DATE: 12123/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DES
101 5023990 567.00 REFUND
317 +276+5172 LILLY 05:10:02 p.m. 12 -09 -2008 1 /1
uw Vv GUVV IUL V4-UG III VII yr VnaI1GL OVO rnA Irv. JI(;)I1G4ou rl VI /V1
Of CA,7,;1 "COMPLETE RETURN
+'w REFUND REOUEST THIS FORM TO:
Buildrng c' Code Servlcs City of Carmel
k�kk K
Ph. (317) 571 -2444 fax (317) 571 -2$99 Building &t Code Services
One Civic Square;
Carmel, IN 46032
PERMIT
Lot Subdivision, or Address of Construction:
L-0 SM6K& Q d e,
(If more than one address needs to be T sted and W not Prt, please attach a printed list of all permits, with
their corresponding permit if.)
Please print or type the reason for the requested refund, and specific fee or fees
which are requested, in th fi nes below:
t?�rt;rre I iUl nPrrr> �n _►e- maun�
I ytl(1_ i Xmi u� h,P,rt pu. LeA An d c SMI PCb Qd
ern,} Jr. o bp-MLf0 1� �e a -ec�
c1n �r►� e k S
TOTAL REFUND AMOUNT REQUESTED:
57 00
Applicant 54W +..1 Date
�R�6ol� A,
Applicant Name Printed Company )mama (If applicable)
APPL ICANT ADDRESS:
Street Address
C o I Al gG033
City ST Zip
I arlwlWwTIM11
Phone Pax ;It
FOR Q FFICE USE ONL
p Total amount for fees that ARE available for refund;
p Fees that are NOT available for refund;
p Refund approved by: Date.
p Date submitted for payment; Amount Approved:
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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.
Payee
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.
t
ALLOWED 20
A. C,�X
IN SUM OF
13 -7a
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or DEPT INVOICE NO. ACCT #/TITLE OUNT I hereby certify that the attached invoice(s), or
:5a L o' �SG .cY 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
2 -20 ol(
E�i qnatu
i
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund