250267 10/07/15 u!.C�gyF
CITY OF CARMEL, INDIANA VENDOR: 369953
® i) ONE CIVIC SQUARE DAVID HORTON CHECK AMOUNT: $""`"148.50"
:. ?4 CARMEL, INDIANA 46032 12938 PONTELL PLACE CHECK NUMBER: 250267
'M,�_oH.�: WESTFIELD IN 46074 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 1458098 148.50 REFUNDS AWARDS & INDE
I'
GLOBAL REFUND RECEIPT
Receipt# 1458098
Carmel o !a CF�r v� Payment Date: 09/24/15
J _.� Household #: 22613
Parks&Recreation
SEP 2 g 2015
ICY:
Monon Community Center David Horton Hm Ph: (317)873-4757
Carmel IN 46032 12938 Pontell Place Wk Ph: (317)338-2269
Westfield IN 46074 Cell Ph:(317)219-8963
davidrhorton@yahoo.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Pass Management 148.50- 148.50 0.00
PREVIOUS NET HOUSEHOLD BALANCE 148.50
Processed on 09/24/15 @ 09:50:08 by JAB NEW REFUND AMOUNT(-) 148.50
TOTAL REFUNDABLE AMOUNT 148.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 148.50 Made By==>REFUND FINAN With Reference=_>parent request;81-10-4358400 refund
All ref nds ar ubject to St e oars d of�Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
Authorized gnatur 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.
Horton, David Terms
12938 Pontell Place Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/24/15 1458098 Refund $ 148.50
Total $ 148.50
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
Voucher No. Warrant No.
Horton, David Allowed 20
12938 Pontell Place
Westfield, IN 46074
In Sum of$
$ 148.50
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-10 1458098 4358400 $ 148.50 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
October 1, 2015
Signature
$ 148.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund