246254 06/17/15 ���.�,q,f CITY OF CARMEL, INDIANA VENDOR: 368208
`� CHECK AMOUNT: $*******121.50*
.� ,• ONE CIVIC SQUARE MELODY COCKRUM
9 /_� CARMEL, INDIANA 46032 12838 HORSEFERRY ROAD CHECK NUMBER: 246254
�'��TON�°, CARMEL IN 46032 CHECK DATE: 06/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 1451428 121.50 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1451428
C. CCI Payment Date: 06/10/15
Household#: 20490
Nr Aecr ation
Monon Community Center. Melody Cockrum Hm Ph: 317 645-5345
Carmel IN 46032 12838 Horseferry Rd. Wk Ph: �317�688-2061
Carmel IN 46032 Cell Ph:(317)645-5345
melcockrum@yahoo.com(317)848-7275 elcockrum@yahoo.com
Fed Tax ID#35-6000972
Refund Details
Orio Bal Refund New Bal
Module: Pass Management 121.50-. 121.50 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 121.50
Processed on 06/10/15 @ 11:07:36 by BJJ NEW REFUND AMOUNT(-) 121.50
TOTAL'REFUNDABLE AMOUNT- ;
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 121.50 Made By==>REFUND FINAN With Reference=_>1081-10-4358400pf�
All refunds are subject to State Board of Accounts procedures and may take 4-6 ks to process. No cash refunds will be
issued.
uth ' 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.
Cockrum, Melody Terms
12838 Horseferry Rd Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/10/15 1451428 Refund $ 121.50
Total $ 121.50
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
I
Voucher No. Warrant No.
..Cockrum, Melody Aiiowed 20
12838 Horseferry Rd
Carmel, IN 46032
In.Sum of-$
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$ 121.50 I
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
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DepDept Board Members
INVOICE NO. ACCT#/TITL AMOUNT i
1081-10 1451428 4358400 $ 121.50 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
I
i
June 12, 2015
'j
Signature
$ 121.50 j Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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