HomeMy WebLinkAbout164355 09/30/2008 CITY OF CARMEL, INDIANA VENDOR: T361404 Page 1 of 1
0 ONE CIVIC SQUARE NORMA SMITH CHECK AMOUNT: $210.68
CARMEL, INDIANA 46032 14170 STACEY STREET
CARMEL IN 46033 CHECK NUMBER: 164355
CHECK DATE: 9130/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
:101 5023990 210.68 REFUND
09/19/2008 07:22 3175690640 #0010 P.001 /001
SEP -17 -2008 FLED 08:55 M CITY OF CARMEL BCS FAX NO. 3175712499 P. 02
Y Q`' "COMPLETE RETYJRN
REFUND REQUEST THIS FORM TO:
Sufldmg Cade Services City of Carmel
P.h. (317) 571 -2444 Fax (317) 571 -2499 Mding Code Services
va,bc�a One Cite.Square;
Cannel, iN 46032
%7 -2q9
PERMIT #(s): Co
Lot Subdivision, or Address of Construction:
(If more than one address neeft to be fisted Fled will not fit, please gtgq� a t of all permsts, with
their correspo permit #.j
Please print or type the reason for the requested refund, and specific fee or fees
which are requested, in the lines below:
iJVercha c� �A:MP<T'f�a64Z
TOTAL REFUND AMOUNT REQUESTED: oZ 10.•
1 IC
Applicant Signature
Date
Applicant Name Printed Company flame (If applicable)
APPLICANT ADDRESS:
l�il�0 S�oce� �t
m� K) <fC�033
0tv sr Zip
Phone Fax
FOR OI+FI" U$g nuly
I
P Total amount for fees that ARE available for refwd;
P Fees that are NOT available for refund; I
P Refund approved b
y- 1 ate: f aa.l oY�
R Dat 1 b I
I e sunntitted for payment» (a3 AmoUAt Approved• D
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))
a? lD
Total g
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.
�P
J m t �;k ALLOWED 20
IN SUM OF
//(1 loD�3
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
/D :�Od 3 d l0 (Q8 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
qj 2(O6
Sigh e��
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund