HomeMy WebLinkAbout168677 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: T362480 Page 1 of 1
ONE CIVIC SQUARE SCOTT ROBERTS
R` CARMEL, INDIANA 46032 457 BURLINGTON CHECK AMOUNT: $290.68
CARMEL IN 46032
CHECK NUMBER: 168677
CHECK DATE: 2/4/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 290.68 REFUNDS AWARDS INDE
1441 76 300.9 36 WO
000211771
O@Oory &000 0
Motion Center Clerk: ARH
Date: 12/21/2008 Time: 17:03:53�`�
H /H: Scott Roberts
F /M: Scott Roberts
Description Ext Price
Pass 0 Type 749.32
Prem. Yrly HH R
From 04/02/2008 04/02/2009
F /M: Jack Roberts
Description Ext Price
Pass 0 Type 0.00
Prm Yr HH Add R
From 04/02/2008 04/02/2009
F /M: Max Roberts
Description Ext Price
Pass 0 -,Type 0.00
Prm Yr HH Add R
From 04/02/2008 04/02/2009
F /M: Kris Bowen Roberts
Description Ext Price
Pass 0 Type 0.00
Prm Yr HH Add R
From 04/02/2008 04/02/2009
F/M: Bianca Schmidt Hamilton
Description Ext Price
Pass 0 Type 0.00
Prm Yr HH Add R
From 04/02/2008 04/02/2009
Page 1
000211771
F /M: Parke Rae Hamilton
Description Ext Price
Pass 0 Type 0.00
Prm Yr HH Add R
From 04/02/2008 04/02/2009
F /M: Joan Roberts
Description Ext Price
Pass 0 Type 0.00
Prm Yr HH Add R
From 05/02/2008 05/02/2009
Rcpt# 211771 Prev Bal: 0.00
New Charges 290.68
New Tax: 0.00
Total Due: 290.68
Tot Refund: 290.68
New Bal: 0.00
Refund Type: Refund from Finance
REFUND FINAN Refund of: 290.68
All refunds are subject to state Board
of Accounts claim procedure and may take
4 -6 weeks to process. A check will be
issued. No cash or credit card refunds.
Authorized signature Date
Authorized signature Date
0! .1
Rcpt# 211771
Om
Page 2
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; k n d of service,
where
rice performed a dates service rendered, by
whom, rates per day, number of hours, rate per hour,
Payee Purchase Order No.
Terms
Roberts, Scott Date Due
a 457 Burlington
Carmel, IN 46032
Invoice
Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s)) 280.68
12121108 211771 Refund
Total 290.68
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.
Roberts, Scott Allowed 20
457 Burlington
Carmel, IN 46032
in Sum of
290.68
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 211771 4358400 290.68 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
2 -Feb 2009
Signature
290.68 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund