250287 10/07/15 i t4_A
CITY OF CARMEL, INDIANA VENDOR: 369935
d ONE CIVIC SQUARE JOHN INGERSOLL CHECK AMOUNT: $**....**27.00*
f: ?� CARMEL, INDIANA 46032 3169 WILDMAN LANE CHECK NUMBER: 250287
CARMEL IN 46032 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 27.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1458091
Carmel * is\/ Payment Date: 09/24/15
rks&RecrEBtidnSEP 28 2015 Household #: 3732
BY:
Monon Community Center John Ingersoll Hm Ph: (317)733-8146
Carmel IN 46032 3169 Wildman Lane Wk Ph: (800)854-6011
Carmel IN 46032 Ext. 4022
jingersoll@metlife.com Cell Ph:
Phone: (317)848-7275
Fed Tax ID#35-6000972
Refund Details
Orio Bal Refund New Bal
Module: Pass Management 27.00- 27.00 0.00
PREVIOUS NET HOUSEHOLD BALANCE 27.00
Processed on 09/24/15 @ 09:41:30 by JAB NEW REFUND AMOUNT(-) 27.00
TOTAL REFUNDABLE AMOUNT 27.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 27.00 Made By=_>REFUND FINAN With Reference=_>parent request;81-10-4358400 refund
All rends-are subjectto Sta�oard'of Accourifs`procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
"',—AuthorizedAignature Date Authorized Signature Date
Escape Day Passes are non-refundable.
I
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.
Ingersoll, John Terms
3169 Wildman Lane Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9124115 1458091 Refund $ 27.00
_I
Total $ 27.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Ingersoll, John Allowed 20
3169 Wildman Lane
Carmel, IN 46032
In Sum of$
$ 27.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITL AMOUNT
1081-10 1458091 4358400 $ 27.00 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
October 1, 2015
Signature
$ 27.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund