Loading...
HomeMy WebLinkAbout211765 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 366473 Page 1 of 1 ONE CIVIC SQUARE PATRICIA HAGAN i CARMEL, INDIANA 46032 3760 SIMMERMAN CT CHECK AMOUNT: $350.00 <.roH`off CARMEL IN 46033 CHECK NUMBER: 211765 CHECK DATE: 8/14/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 853 5023990 REFUND 350 . 00 OTHER EXPENSES Carmel ® Clay Parks&Recreation CHECK REQUEST Date: _412o l aol a I . ..,. 's - �VED JUL 19 2012 Check payable to: --_._---- Name: Po,-- "rida Haevn Address: � (Q O &m Mey-YV1B-�l C� City, State, Zip C&V ant,I i IN 4 U O 3 3 X Mail check to payee Return check to requestor Check Amount: $ 3 C-0.oo Date Required: 8131 1.0ol a Check needed for: Re6kd due. h nn, l map- w f1 jnLl m a, Cnwa���fi VZ i �vte .W MVN� 'Soe d Ne bid. add yo � IVI To be paid from: PO#(if applicable) Budget account-GL# PC75-7�3 Budget Line Description T 7L — 61-r P_ )C/J Invoice(s)and Purchase Order(if required) MUST be attached. Requested by(print): Requested by(signature): Approved by(signature of Division Manager): t on this date "711 Form revised 7-7-08 Shared/Forms/Business Services/Check Request Form/Check Request(rev 7-7-08) Carmel 0 Clay Parks&Recreation Connemoratave Tree Orde6 d=orm Date: k"A `f J- c2 0 i Z u Name of purchaser(s): �f}T t HAC it 1,( Address: O 51 M M L t2 ate/{N T City,State,Zip: k✓ L I t j 4 6 0 3,3 Contact Phone: 1 7-J X -2 -U 8 Lt Email: Oct-f+ A I I vi ��- ✓1 C� 9 � Name of the person(s)whom the tree commemorates: �.q 1 2 1 C 1 A "0L i-I C-F-7-C Occasion in which the tree commemorates: t(n i.s a: nee���c?;' ci J h e. 06,_J Dec-20 " I All trees are$350.00.*Please indicate the tree purchase and quantity: _Norway Spruce Sugar Maple _Winter King Hawthorn _Colorado Blue Spruce _Red Oak White Oak American Hornbeam No preference _Red Maple _Black Maple Serviceberry �u _Redbud _Tuliptree Ginko(male) The commemorative tree should be labeled with a plaque that reads as follows(max 50 characters including ; r' spaces): c(o. a,^c� P n c^ u.a e A C.C_ a In icate any specific 4rrangements(park preference,location,date,time,etc.): 'l\re i2 r t�r— 4Q, '1` ` "( c n e- -t -1-o •- l` m© ric ;1 Test n cc N o e-vt fc *The above cost includes the purchase amounts for the tree,plaque,and the general maintenance for the lifetime of the tree.If there should be an untimely demise of the tree within the 1s`year,the tree will be replaced at no additional cost,however,if the tree perishes after the It`year,the tree will not be replaced at the expense of Carmel Clay Parks&Recreation. TOTAL AMOUNT PAID: $ 3 0-O C METHOD OF PYMT:_Visa/MC AmExp _X Check(# 173 a ) I hereby authorize payment from my VISA,MASTERCARD,or AMERICAN EXPRESS as follows: Credit Card Information(Card may be requested for verification) CARD NUMBER EXP.DATE (mm/yy) BILLING ZIPCODE CARDHOLDER NAME(Please Print) AUTHORIZED SIGNATURE RETURN COMPLETED FORM TO: Carmel Clay Parks&Recreation,Attn: Rebecca Schmiesing 1411 E.116`h St.,Carmel,IN 46032 Phone:317.571.4144 Email:rschmiesing @carmelclayparks.com C D mAY 0 7 2012 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. Terms Hagen, Patricia 3760 Simmerman Ct. Carmel, IN 46033 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 7/20/12 Refund Refund requested $ 350.00 Total $ 350.00 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. Allowed 20 Hagen, Patricia 3760 Simmerman Ct. Carmel, IN 46033 In Sum of$ $ 350.00 ON ACCOUNT OF APPROPRIATION FOR 853 -Gift Fund PO#or INVOICE NO. ACCT#1TITLE AMOUNT Board Members Dept# 853 Refund 5023990 $ 350.00 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 9-Aug 2012 Signature $ 350.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund