250193 1 0/07/1 5 � Coq.
'''f CITY OF CARMEL, INDIANA VENDOR: 369947
I; ® "sl ONE CIVIC SQUARE XUAN DING CHECK AMOUNT: $ .....117.00*
�. CARMEL, INDIANA 46032 3101 WILDMAN LANE CHECK NUMBER: 250193
'.y�,_oN Lo, CARMEL IN 46032 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 117.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1458092
carme I 0 C lay Payment Date: 09/24/15
J7SE
`(��� Household#: 14464
Parks&Recreation --
2015Monon Community Center Xuan Ding Hm Ph: (317)873-3364
Carmel IN 46032 3101 Wildman Ln. Wk Ph: (317)433-6699
Carmel IN 46032 Cell Ph:(317)946-9518
ding_xuan@lilly.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Pass Management 117.00- 117.00 0.00
PREVIOUS NET HOUSEHOLD BALANCE 117.00
Processed on 09/24/15 @ 09:42:53 by JAB NEW REFUND AMOUNT(-) 117.00
TOTAL REFUNDABLE AMOUNT 117.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 117.00 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
issued.
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f -
Authorized Signature Date Authorized Signature Date
Escape Day asses 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.
Ding, Xuan Terms
3101 Wildman Ln Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/24/15 1458092 Refund $ 117.00
Total $ 117.00
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
, 20_
Clerk-Treasurer
Voucher No. Warrant No.
Ding, Xuan Allowed 20
3101 Wildman Ln
Carmel, IN 46032
In Sum of$
$ 117.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1081-10 1458092 4358400 $ 117.00 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
$ 117.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
a