HomeMy WebLinkAbout221604 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 367233 Page 1 of 1
ONE CIVIC SQUARE ANTHONY LENOIR
CARMEL, INDIANA 46032 2011 WAVERLY DR CHECK AMOUNT: $384.82
KOKOMOIN 46902
CHECK NUMBER: 221604
CHECK DATE: 7/2/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 384 . 82 OTHER EXPENSES
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CITY�b 'OF ARMEL
JAMEs BRmNAm, MAYOR
[tine 28, 2013
Anthony Lenoir
2011 Waverly Drive
Kokomo, IN 46902
RE: Ticket# 20122842:1 D.O.S. 06/30/2012
Dear Anthony Lenoir:
Enclosed you will find a reimbursement check in the amount of$ 384.82.
On September 12, 2012 we received your payment for $ 384.82 and
State Farm paid $ 384.82 on March 22, 2013.
The overpayment is your refund for $384.82
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. COI iTS HEADQUARTERS
Two CIVIC SQUARE, CARnIEL, IN 46032 OFFICE 317.771.2600, FAx 317.571.2615
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A/R Detail
Type Transaction Adjudication Entered Amount Reference Memo Status
Date Date Date Number
Invoice 06130/12 06/30/12 06/29/12 $384.82 Posted
Payment 09/13/12 09/13/12 09/12/12 ($384.82) CK IF12-0 ANTHONY LENOIR CIPosted
Payment 03/22/13 03/22/13 03/22/13 ($384.82) CK 1 18 476535 J STATE FARM Posted
Credit 06/28/13 06/28/13 06/28/13 $384.82 REFUND PATIENT ANTHONY LENOIR Posted
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form 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 3�y �a-
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 $
Y�o�o Mp �� �•�,�.s�'a-
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
JUL
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund