211130 07/19/2012 CITY OF CARMEL, INDIANA VENDOR: 366423 Page 1 of 1
ONE CIVIC SQUARE PAUL G KOS
CARMEL, INDIANA 46032 1314 HEMLOCK ST CHECK AMOUNT: $629.61
CARMEL IN 46033 CHECK NUMBER: 211130
CHECK DATE: 7/1912012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 629 . 61 REFUND
Prescribed by State Board of Accounts
Form No.301(Rev.1995) ACCOUNTS PAYAB E VOUCHER
ADDRESS
Invoice Date Invoice Number Item Amount
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.
7//911 z /),Z- G;:iy
Mo. Day Yr. Officer Title
Voucher No. Warrant No.
ACCOUNTS PAYABLE DETAILED ACCOUNTS
MUNICIPAL WATER DEPT. ANO.
CARMEL, INDIANA
Favor Of
C.e-vhe, O 3
Total Amount of Voucher $
Deductions
a
Amount of Warrant $
Month of Yr
Acct.
VOUCHER RECORD No.
Source of Supply
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
Total
Allowed
Board of Control
Filed
Official Title
BOYCE FORMS.SYSTEMS 1-800-382-8702 325