208982 05/16/2012 CITY OF CARMEL, INDIANA VENDOR: ':..366243 Page 1 of 1
ONE CIVIC SQUARE LUIS OR SUE LLERENA
CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 8713 BAY POINTE CIRCLE
INDIANAPOLIS IN 46236 CHECK NUMBER: 208982
CHECK DATE: 5/1612012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 100.00 REFUND
Prescribed by State Board of Accounts
Form No. 301 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER
To A e�
ADDRESSO C r
Invoice Date Invoice Number Item Amount
i� 1
I 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
Mo. Day Yr. Signature Title
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.
Mo. Day Yr. ficer Title
Voucher No. Warrant No.
ACCOUNTS PAYABLE DETAILED ACCOUNTS
MUNICIPAL WATER DEPT. ACCT.
NO.
CARMEL, INDIANA
Favor Of
8" 71
y ^0
Total Amount of Voucher
Deductions
�C Q
Amount of Warrant
Month of Yr
VOUCHER RECORD Acct.
No.
Source of Suppl
Water Treatment
Transmission and Dist.
Customer Accounts
Administrative and General
Operation- Maintenance
Utility Plant in Service
Constr. Work in Progress
Materials and Supplies
Customers Deposits
I
Total
Allowed
r
Board of Control
Filed
Official Title
BOYCE FORMS SYSTEMS 1- 800- 382 -8702 325