231210 04/08/2014 ♦W.C,qN�
CITY OF CARMEL, INDIANA VENDOR: 368113
ONE CIVIC SQUARE MORI DECRAENE CHECK AMOUNT: $'"""**""15.00'
CARMEL, INDIANA 46032 14519 BALDWIN LANE CHECK NUMBER: 231210
CARMEL IN 46032 CHECK DATE: 04/08/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 1229788 15.00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 1229788
�' � i� Payment Date: 03/27/14
Household #: 57855
arks&Recreation
Smoky Row Elementary MAR 2 7 Mori Decraene Hm Ph: (317) -
900 West 136th Street 14519 Baldwin Ln Wk Ph: (317) -
Carmel IN 46032 Carmel IN 46032 Cell Ph:(574)339-0944
mori2709@yahoo.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Refund Details
Orio Bal Refund New Bal
Module: Activity Registration 15.00- 15.00 0.00
PREVIOUS NET HOUSEHOLD BALANCE 15.00
Processed on 03/27/14 @ 11:43:22 by AEB NEW REFUND AMOUNT(-) 15.00
I TOTAL REFUNDABLE AMOUNT 15.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 15.00 Made By=_>REFUND FINAN With Reference=_>
M
re:ature
to Sta rd of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
d SDate Authorized Signature Date
Escape Day Passes are non-refundable.
V
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Page# 1 of 1
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.
Decraene, Mori Terms
14519 Baldwin Ln Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/27/14 1229788 Refund $ 15.00
Total $ 15.00
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.
Decraene, Mori Allowed 20
14519 Baldwin Ln
Carmel, IN 46032
In Sum of$
$ 15.00
I
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITL AMOUNT
1081-99 1229788 4358400 $ 15.00 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
3-Apr 2014
Signature
$ 15.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund