250473 1 0/07/1 5 CITY OF CARMEL, INDIANA VENDOR: 369933
® it ONE CIVIC SQUARE MAN XU CHECK AMOUNT: $ ..."'70.00'
4'• ?� CARMEL, INDIANA 46032 12943 TUSCANY BLVD CHECK NUMBER: 250473
1,y,`TON. CARMEL IN 46032 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 1458069 70.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1458096
Carme 1 1& C la Payment Date: 09/24/15
Parks&Reereatio CPY"-ED
Household #: 43884
SEP 2g 2015
Monon Community Center Jian Xu Hm Ph: (317)733-8018
Carmel IN 46032 12943 Tuscany Blvd
Carmel IN 46032 Cell Ph:
jianusmail@gmail.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Refund Details
Orio Bal Refund New Bal
Module: Pass Management 70.00- 70.00 0.00
PREVIOUS NET HOUSEHOLD BALANCE 70.00
Processed on 09/24/15 @ 09:48:03 by JAB NEW REFUND AMOUNT(-) 70.00
TOTAL REFUNDABLE AMOUNT 70.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 70.00 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."-
ssued. /I
— --
o� �' q
Authorize 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.
Xu, Jian Terms
12943 Tuscany Blvd Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/24/15 1458096 Refund $ 70.00
Total $ 70.00
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.
Xu, Jian Allowed 20
12943 Tuscany Blvj
Carmel, IN 46032
In Sum of$
$ 70.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-10 1458096 4358400 $ 70.00 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
$ 70.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund