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249771 09/23/15 CITY OF CARMEL, INDIANA VENDOR: 369881 i, .;; ® 1• ONE CIVIC SQUARE BONNIE KRUSZKA-AMMERMAN CHECK AMOUNT: S........52.00' CARMEL, INDIANA 46032 12012 BRANLEY COURT CHECK NUMBER: 249771 ?birtiN co` CARMEL IN 46032 CHECK DATE: 09/23/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4358400 52.00 REFUNDS AWARDS & INDE GLOBAL REFUND RECEIPT Receipt# 1457597 Carmel Clay Payment Date: 09/09/15 Warks&Recreation Household #: 4619 Monon Community Center Bonnie Kruszka-Ammerman Hm Ph: (440)487-2663 Carmel IN 46032 SEP ; © 2u'15 12012 Branley Ct. Wk Ph: (317)338-4040 Carmel IN 46032 Cell Ph:(440)487-2663 bonnie.kruszka@gmail.com Phone: (317)848-7275 Fed Tax ID#35-6000972 Refund Details Oria Bal Refund New Bal Module: Pass Management 52.00- 52.00 0.00 PREVIOUS NET HOUSEHOLD BALANCE 52.00 Processed on 09/09/15 @ 09:59:20 by JAB NEW REFUND AMOUNT(-) 52.00 TOTAL REFUNDABLE AMOUNT 52.00 NEW NET HOUSEHOLD BALANCE 0.00 Refund of=_> 52.00 Made By==>REFUND FINAN With Reference=_>parent request;81-10-4358400 refund All ds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be is Au th rized ignature 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. Kruszka-Ammerman, Bonnie Terms 12012 Branley Ct Date Due Carmel, IN 46032 Invoice Invoice Description Date Number or note attached invoice(s) or bill(s)) Amount $ 52.00 9/9/15 1457597 Refund Total $ 52.00 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. Kruszka-Ammerman, Bonnie Allowed 20 12012 Branley Ct Carmel, IN 46032 In Sum of$ $ 52.00 ON ACCOUNT OF APPROPRIATION FOR 108 -ESE PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1081-10 1457597 4358400 $ 52.00 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 September 17, 2015 Signature $ 52.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund