236115 08/19/14 (9, )
CITY OF CARMEL, INDIANA VENDOR: 368573
ONE CIVIC SQUARE - KELLY ADAMS CHECK AMOUNT: $********72.00*
CARMEL, INDIANA 46032 10100 SHELBOURNE CHECK NUMBER: 236115
CARMEL IN 46032 CHECK DATE: 08/19/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 1328947 72.00 REFUNDS AWARDS & INDE
i
GLOBAL REFUND RECEIPT
Receipt# 1328947
r � _ Payment Date: 08/13/14
r—v Household#: 12948
Parks&Recrea 01
AUG 14214 i
Mo non Community Center BY: Kelly Adams
Carmel IN 46032 _. 10100 Shelbourne Wk Ph: (317)872-8368
- Carmel IN 46032 Cell Ph:(574)903-3901
kminadams@yahoo.com
Phone:.(317)848-7275
Fed Tax ID#35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Activity Registration 67.00- 67.00 0.00
Module: Pass Management 5.00- 5.00 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 72.00
Processed on 08/13/14 @ 13:31:30 by BJJ NEW REFUND AMOUNT(-) 72.00
TOTAL REFUNDABLE AMOUNT 72.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 72.00 Made By==>REFUND FINAN With Reference-_>1082-:take
8400iO.J�
All refun s are subject to State Board of Accounts procedure d ma 4-6 w No cash refunds will be
issued
(�4q_4
Aut zed Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
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.
Adams, Kelly Terms
10100 Shelbourne Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number . (or note attached invoice(s) or bill(s)) Amount
8/13/14 1328947 Refund $ 72.00
Total Is 72.00
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
i
Voucher No. Warrant No.
Adams, Kelly I Allowed 20
10100 Shelbourne
'Carmel, IN IN 46032
In Sum of$
$ 72.00
l
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE !
PO#or Board Members
De t# INVOICE NO. ACCT#/TITL AMOUNT �
P
1082-11 1328947 4358400 $ 72.00 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
14-Aug 2014
1'
Signature
$ 72.00 Accounts Payable Coordinator
Cost distribution ledger classification if, Title
claim paid motor vehicle highway fund