242185 2 /17/2015 r.Cqq
CITY OF CARMEL, INDIANA VENDOR: 369105
ONE CIVIC SQUARE JUSTINA ADAMS CHECK AMOUNT: $ ....'352.00"
CARMEL, INDIANA 46032 10375 ORCHARD PARK DR CHECK NUMBER: 242185
M.roN Via, INDIANAPOLIS IN 46280 CHECK DATE: 02/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 1404564 352.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1404564
Carmel 0 ClayPayment Date: 02/11/15
Parks&Recreation Household #: 33874
Monon Community Center Justina Adams Hm Ph: (317)557-1062
Carmel IN 46032 10375 Orchard Park Dr.
Indianapolis IN 46280 Cell Ph:
justinanoel@comcast.net
Phone: (317)848-7275
Fed Tax ID#35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Activity Registration 352.00- 352.00 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 352.00
Processed on 02/11/15 @ 09:19:03 by BJJ NEW REFUND AMOUNT(-) 352.00
TOTAL REFUNDABLE AMOUNT 352.00,
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 352.00 Made By=_>REFUND FINAN With Reference =>parent request
All refunds are subject to State Board of Accounts procedures a e 4-6 weeks to process. No cash refunds will be
issued.
ut ed 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, Justina Terms
10375 Orchard Park Dr Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/11/15 1404564 Refund $ 352.00
Total $ 352.00
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
Voucher No. Warrant No.
Adams, Justina Allowed 20
10375 Orchard Park Dr
Indianapolis, IN 46280
In Sum of$
$ 352.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITL AMOUNT
1082-11 1404564 4358400 $ 352.00 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
February 13, 2015
V • �y��u
Signature
$ 352.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund