HomeMy WebLinkAbout250198 10/07/1 5 +u,G4q�f`
�; CITY OF CARMEL, INDIANA VENDOR: 369948
® ONE CIVIC SQUARE AMO DYKSTRA CHECK AMOUNT: $********76.00*
° CARMEL, INDIANA 46032 10257 BRAIR CREEK LANE CHECK NUMBER: 250198
9Mf>ON GO CARMEL IN 46033 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 20813 76.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1458100
Carmel o lay Payment Date: 09/24/15
Household #: 2446
Parks&t�ecreat�on 7Y:
���T���Monon Community Center P 2 8 2015 Arno Dykstra Hm Ph: (317)844-6681
Carmel IN 46032 10257 Briar Creek Lane Wk Ph: (317) -
_______ i Carmel IN 46033 Cell Ph:(317)416-9528
Phone: (317)848-7275
Fed Tax ID#35-6000972
PREVIOUS NET HOUSEHOLD BALANCE 76.00
Processed on 09/24/15 @ 09:51:32 by JAB NEW REFUND AMOUNT(-) 76.00
TOTAL REFUNDABLE AMOUNT 76.00'
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 76.00 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
Authorized�Jg ature Date Authorized Signature Date
Escape ay P sses 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.
Dykstra, Amo Terms
10257 Briar Creek Lane Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/24/15 1458100 Refund $ 76.00
Total $ 76.00
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.
Dykstra, Amo Allowed 20
10257 Briar Creek Lane
Carmel, IN 46033
In Sum of$
$ 76.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or
Dept# INVOICE NO. ACCT#/TITL AMOUNT Board Members
1081-10 1458100 4358400 $ 76.00 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
$ 76.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
*Y'