246392 06/1 7/1 5 1�r,C�q�
�/ � CITY OF CARMEL, INDIANA VENDOR: 369484 ,,,,,,,,,,,,,,,, t
•li ® °;• ONE CIVIC SQUARE STACY KELLEY
CHECK AMOUNT: $ 94.50
9, �,�� CARMEL, INDIANA 46032 4057 TEAGUE PLACE CHECK NUMBER: 246392
�,TON,�, CARMEL IN 46032 CHECK DATE: 06/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 94.50 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1451425
Came] Clay Payment Date: 06/10/15
Household#: 21066
Nr &' cratilorl
Monon Community Center Stacy Kelley Hm Ph: (317)733-8715
Carmel IN 46032 4057 Teague Place Wk Ph: (317)636-5211
Carmel IN 46032 Cell Ph:(317)902-9399
skelleylaw@sbcglobal.net
Phone: (317)848-7275
Fed Tax ID#35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Pass Management 94.50- 94.50 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 94.50
Processed on 06/10/15 @ 11:01:50 by BJJ NEW REFUND AMOUNT(-) 94.50
TOTAL:REFUNDABLE AMOUNT,:.
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 94.50 Made By==>REFUND FINAN With Reference=_>1081-10-4358400 (elt) kez2u�r(
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issu
but 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.
Kelley, Stacy Terms
4057 Teague Place Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/10/15 1451425 Refund $ 94.50
Total $ 94.50
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
120
Clerk-Treasurer
I -
Voucher No. Warrant No.
Kelley, Stacy Allowed 20
4057 Teague Place
Carmel, IN 46032
In Sum of$
$ 94.50
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
I
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-10 1451425 4358400 $ 94.50 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
June 12, 2015
Signature
$ 94.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund