242274 02/17/15 ' 41 us.C�gyF!
.CITY OF CARMEL, INDIANA VENDOR: 369110
ONE CIVIC SQUARE LISA GONG CHECK AMOUNT: $**.....*45.00*
r° CARMEL, INDIANA 46032 5822 APPLEGATE CT CHECK NUMBER: 242274
9M,roN Eo, CARMEL IN 46033 CHECK DATE: 02/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 1404820 45.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1404820
Garde! 0 Clay Payment Date: 02/12/15
Narks&Rccrcation Household #: 49836
Monon Community Center FEB 12 2015 „ ( Lisa Gong
Carmel IN 46032 5822 Applegate CT
Carmel IN 46033 Cell Ph:
BY: samyishen@msn.com
Phone: (317)848-7275 `—`
Fed Tax ID#35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Activity Registration 45.00- 45.00 0.00
PREVIOUS NET HOUSEHOLD BALANCE 45.00
Processed on 02/12/15 @ 10:32:55 by JAB NEW REFUND AMOUNT(-) 45.00
TOTAL REFUNDABLE AMOUNT 45.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 45.00 Made By==>REFUND FINAN With Reference=_>parent request;81-99-4358400 refund
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
Atfior'zed
C7signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
Page# 1 of 1
L
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.
Gong, Lisa Terms
5822 Applegate CT Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/12/15 1404820 Refund $ 45.00
Total $ 45.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Gong, Lisa Allowed 20
5822 Applegate CT
Carmel, IN 46033
In Sum of$
$ 45.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept#
1081-99 1404820 4358400 $ 45.00 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 12, 2015
Y)A0h&-k"W
r
Signature
$ 45.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund