250459 10/07/15 +ter.C�9.*F
a;' ;� CITY OF CARMEL, INDIANA VENDOR: T360122
;; ® i. ONE CIVIC SQUARE JUSTIN VINCENT CHECK AMOUNT: $ .....208.00"
CARMEL, INDIANA 46032 13332 PENNINGER DR CHECK NUMBER: 250459
� a WESTFIELD IN 46074 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 1458095 208.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1458095
Carmel 1& Clay Payment Date: 09/24/15
Household #: 5318
darks&t�ecreatialn 7Y.-
`������Monon Community Center P 2 8 2 115 Justin Vincent Hm Ph: (317)366-1068
Carmel IN 46032 13332 Penniger Dr Wk Ph: (317)344-7222
Westfield IN 46074 Cell Ph:
melievincent@gmail.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Pass Management 208.00- 208.00 0.00
PREVIOUS NET HOUSEHOLD BALANCE 208.00
Processed on 09/24/15 @ 09:46:49 by JAB NEW REFUND AMOUNT(-) 208.00
TOTAL REFUNDABLE AMOUNT 208.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 208.00 Maade'By=_>REFUND FINAN With Reference=_>parent request;81-10-4358400 refund
All refunds e subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
L?l
Authorize Sign ture 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.
Vincent, Justin Terms
13332 Penniger Dr Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/24/15 1458095 Refund $ 208.00
Total $ 208.00
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.
Vincent, Justin Allowed 20
13332 Penniger Dr
Westfield, IN 46074
In Sum of$
$ 208.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept#
1081-10 1458095 4358400 $ 208.00 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
$ 208.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund