250428 1 0/07/1 5 9, r CAA.
`` *F. CITY OF CARMEL, INDIANA VENDOR: 368431
® ONE CIVIC SQUARE STACY SULLIVAN CHECK AMOUNT: $*******189.50*
CARMEL CARMEL, INDIANA 46032 59 WOODARCE DRIVE CHECK NUMBER: 250428
4,�oN�. CARMEL IN 46032 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 1458102 189.50 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1458102
Carmel 0 Clay =Y:
Payment Date: 09/24/15
Par ks&RecreabonHousehold #: 43908
Monon Community Center tacy Sullivan Hm Ph: (317)292-7797
Carmel IN 46032 59 Woodacre Drive Wk Ph: (317)575-9620
Carmel IN 46032 Cell Ph:(317)292-7797
stacyweddle@yahoo.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Refund Details
Oria Bal Refund New Bat
Module: Pass Management 189.50- 189.50 0.00
PREVIOUS NET HOUSEHOLD BALANCE 189.50
Processed on 09/24/15 @ 10:19:58 by JAB NEW REFUND AMOUNT(-) 189.50
TOTAL REFUNDABLE AMOUNT 189.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 189.50 Made By==>REFUND FINAN—With Reference=_>parent request;81-10-4358400 refund
All refunds are subject to.State'Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issyed_
r
�' —Authorized 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.
Sullivan, Stacy Terms
59 Woodacre Drive Date Due
Carmel, IN 46032
InvoiceA14581
Description
Date (or note attached invoice(s) or bill(s)) Amount
9/24/15Refund $ 189.50
Total $ 189.50
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
Voucher No. Warrant No.
Sullivan, Stacy Allowed 20
59 Woodacre Drive
Carmel, IN 46032
In Sum of$
$ 189.50
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or
Dept# INVOICE NO. ACCT#/TITL AMOUNT Board Members
1081-10 1458102 4358400 $ 189.50 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
$ 189.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund