245922 06/03/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 369409
ONE CIVIC SQUARE KEITH MODGLIN CHECK AMOUNT: $*******282.00*
CARMEL, INDIANA 46032 13239 LORENZO BLVD CHECK NUMBER: 245922
CARMEL IN 46074 CHECK DATE: 06/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 1449092 282.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1449092
cg et Claw Payment Date: 05/26/15
F Household#: 13838
PartsAecreation
Monon Community Center Keith Modglin Hm Ph: (317)873-3046
Carmel IN 46032 ) ~;�`1,x� 13239 Lorenzo Blvd
Carmel IN 46074 Cell Ph:
Phone: (317)848-7275
MAY 2(6 2015 kbm2kl@aol.com
Fed Tax ID#35-6000972
B :
Refund Details
Orin Bal Refund New Bal
Module: Pass Management 282.00- 282.00 0.00
PREVIOUS NET HOUSEHOLD BALANCE 282.00
Processed on 05/26/15 @ 11:02:58 by JAB NEW REFUND AMOUNT(-) 282:00
TOTAL'REFUNDABCE AMOUNT- 282.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 282.00 Made By=_>REFUND FINAN With Reference=_>parent request;81-3-4358400 refund
A un s e sub' t-t65tate Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
sued.
2,0
uthorized Si ature 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.
Modglin, Keith Terms
13239 Lorenzo Blvd Date Due
Carmel, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/26/15 1449092 Refund $ 282.00
Total $ 282.00
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.
Modglin, Keith Allowed 20
13239 Lorenzo Blvd
Carmel, IN 46074
In Sum of$
$ 282.00
h
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICENO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081/3 1449092 4358400 $ 282.00 1. 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
May 28, 2015
Signature
$ 282.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund