215873 12/25/2012 CITY OF CARMEL, INDIANA VENDOR: 366805 Page 1 of 1
` ONE CIVIC SQUARE SALAH AZIZ
CARMEL, INDIANA 46032 5928 DEVINGTON ROAD#4 CHECK AMOUNT: $10.61
INDIANAPOLIS IN 46226
,o CHECK NUMBER: 215873
CHECK DATE: 12/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 10 . 61 AMBULANCE REFUND
41K `
CITY ` Fwr EL
_JAMES BRAINARD, MAYOR
December 17, 2012
Salah Aziz
5928 Devington Rd # 4
Indianapolis, IN 46226
RE: INVOICE #201001021 D.O.S. 04/13/2010
Dear Mrs. Aziz:
Enclosed you will find a reimbursement check in the amount of$10.61.
On November 20, 2012 we received a payment for $80.00 and the amount
due was $69.39. Since you overpaid this invoice, I am issuing you a refund of$10.61.
If you have any questions, please feel free to contact me at (3 17) 571-2604.
Sincerely,
Michelle T. Harrington
Billing Administrator
CARNIEL FIRE DEPARTMENT
STEVEN A. CouTs HEADQUARTERS
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:INDIANAPOLIS IN 46226-2374
PAYEXACTLY:EIGHTY`DOLLARS' NO 'CENTS
$80.00
18111 Huntingiun
To
The Carmel Fire Department
Order Emergency Med Svcs
2 Civic Square
Carmel IN 46032 Void After 121 pays"
11'004006 140311° 1:0440000 241: ❑ 189 19466B610
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Farm No.201(Rev.1995)
CITY OF CARMEL
An invoice or 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
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
_ ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# 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
DEC 17 2012
E�
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund