221793 07/10/2013 CITY OF CARMEL, INDIANA VENDOR: 364344 Page 1 of 1
ONE CIVIC SQUARE CORONADO HOMES CHECK AMOUNT: $1,600.00
1011 S MAPLE CARMEL, INDIANA 46032
FORTVILLE IN 46040 CHECK NUMBER: 221793
CHECK DATE: 7/10/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 REFUND 102 . 00 REFUND
659 5023990 REFUND 1, 498 . 00 REFUND
Prescribed by State Board of Accounts
Form No.301-S(Rev.1997)
ACCOUNTS PAYABLE V U HE
TO 0tLbMADC> �pmLS
ADDREc
Invoice Date Invoice Number Item Amount
01V Lq
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 e e
Mo. Day Yr. SigiVature Title
I hereby certify that the attached invoice(s), or bil s), is (are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6.
i . J,/A/
Mo. Day Yr. Officer Title
I
Voucher No. Warrant No.
ACCOUNTS PAYABLE DETAILED ACCOUNTS
MUNICIPAL WASTEWATER UTILITY ACCT.
CARMEL, INDIANA NO.
( or Of
- c
Total Amount of Voucher
Deductions
_3 D !Oa oO
Amount of Warrant
Month off/ —( Y 6 3
Acct.
VOUCHER RECORD No.
Collection System
Pumping
Treatment&Disposal
Customer Accounts
Administrative&General
Reclaimed Water Treatment
Reclaimed Water Distribution
Total
Allowed
Board Members
Filed
BOYCE FORMS•SYSTEMS 1-800-382-8702 325