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165453 10/29/2008 E CITY OF CARMEL, INDIANA VENDOR: T362065 Page 1 of 1 ONE CIVIC SQUARE RICHARD TAYLOR I= CARMEL, INDIANA 46032 10621 RUCKLE ST CHECK AMOUNT: $33.00 INDIANAPOLIS IN 46280 CHECK NUMBER: 165453 CHECK DATE: 10/29/2008 DEPARTMENT ACCOUNT P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1047 4358400 CK REQUEST. 33..00 REFUNDS AWARDS,.& INDE L o T Carmel i clay Parks &Recreation CHECK REQUEST Date: I C F ED OCT 2 1 2008 r Check payable to BY: s Name: 1� Address, City, State, Zip �JN 4( 1Z Mail check to payee Return check to requestor --REV7U11 D) Check Amount o T� Date Required Check needed for a Zer ra j To be paid from PC (if applicable) ffrny Budget account GL Budget Line Description vv'l(1 Invoice(s) and Purchase Order (if required) MUST be attached. Requested by (print): IM t i_u R Ed I, Requested by (signature): Approved by (signature of Division Manager): on this date Form revised 7 -7 -08 Shared 1 Administrative 1 Forms I Staff forms I Check Request (rev 7 -7 -08) IBC dl� 'Function �I r t? k e Eg �•�o-sn x z r 'c 2;:.' �;E...�r •:�E? ��s rs�Ea�i� z e �a x .�E�...�:e�° _E ,a�aaft' FIRSTMERCHANTS BANKCENTRAL INDIANA. NA 10/160 09,22:40 DEMAND History Inquiry Account Information ACH ]r(juuv Account Number 9000057417 Short dame TAYLOR RICHARD F Nbr Debits 2 Last .Stmt 10 /06/06 Last Stmt Balance :34 Nbr Credits 0 Nbr Enclosed 0 Current Balance 52.66- iAwetarq s. )O, I Non- Momtarv'Adivitt Pack a©e PosF •I Taller Memo 10!15/08 ACH FED AC" 0089 CTY OF CARMEL /MONO 20.00 19,66 10/15/f18 SYS DO OOC 0071 0D /NSF CHRG 33.00 52.66 RIECFIVED I OCT 2 2008 BY: ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. Taylor, Richard Terms 10621 Ruckle St Date Due Indianapolis, IN 46280 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 10/21/08 Ck Req. Refund 33.00 Total 33.00 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 20_ Clerk- Treasurer Voucher No. Warrant No. Taylor, Richard Allowed 20 10621 Ruckle St Indianapolis, IN 46280 In Sure of 33.00 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT #1TITLE AMOUNT Board Members Dept 1047 Ck Req. 4358400 33.00 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 22 -0ct 2008 Signature 33.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund