249672 09/23/15 Cqq .
+f CITY OF CARMEL, INDIANA VENDOR: 369879
® ONE CIVIC SQUARE RON ELLIS CHECK AMOUNT: $ ...."`10.00*
CARMEL, INDIANA 46032 5875 LOST OAKS DR CHECK NUMBER: 249672
,,_,oN. CARMEL IN 46033 CHECK DATE: 09/23/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 10.00 REFUNDS AWARDS & INDE
Receipt #2000081.003 Page 1 of 1
a
Monon Community Center East' SEP 10 2015 Voucher #2000081.003
Building i Sep 9, 2015 9:37 AM
1235 Central Park Dr. East Y
Carmel, IN 46032 --
Phone: (314) 848-7275
FAX: -- Carmel
Email: info@carmelclayparks.com
Parks&Recreation
NATIONAL GOLD MEDAL WINNER
RON ELLIS AND ACCREDITED AGENCY
5875 LOST OAKS DR.
CARMEL, IN 46033
Prepared By: amandaj
Customer ID: 10934
Primary phone: (317) 523-2031, Secondary phone: --
Refund Summary
Check: ($10.00) Check #
Total Received: ($10.00) Total Refund: ($10.00)
Transactions
Customer Description Item Unit Qty Fee Charge
Ethan Ellis Fishin' in the Park#256036-01 Activity Fee Each 1.00 $10.00 ($10.00)
5875 Lost Oaks Dr. Action: Withdraw
Carmel,IN 46033 Withdrawal Date: Sep 9, 2015
Primary phone:(317)523-
2031 Meets: September 11, 2015
Email:-- Friday from 6pm to 7:30pm
ID: 24522 Location: Wilfong Pavilion (Whole) at
Founders Park
Total Charges ($10.00)
Total Payments ($10.00)
Balance $0
https:Hactivenet023.active.com/carmelclaypai-ks/servlet/processReceiptPaynient.sdi 9/9/2015
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.
Ellis, Ron Terms
5875 Lost Oaks Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/9/15 2000081003 Refund $ 10.00
Total $ 10.00
I 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.
Ellis, Ron Allowed 20
5875 Lost Oaks Dr
Carmel, IN 46033
In Sum of$
$ 10.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1096-42 2000081003 4358400 $ 10.00 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
PAO
Signature
$ 10.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund