303604 09/29/16 CITY OF CARMEL, INDIANA VENDOR: 367750
ONE CIVIC SQUARE KAREN DEBOER CHECK AMOUNT: $********1 1.00*
CARMEL, INDIANA 46032 1030 CHURCHILL COURT CHECK NUMBER: 303604
9 �roN INDIANAPOLIS IN 46280 CHECK DATE: 09/29/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 2000407006 11.00 REFUNDS AWARDS & INDE
Voucher No. Warrant No.
Deboer, Karen Allowed 20
1030 Churchill Court
Indianapolis, In 46280
In Sum of$
$ 11.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-70 2000407006 4358400 $ 11.00 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
September 21, 2016
&I[LI
Signature
$ 11.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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.
Deboer, Karen Terms
1030 Churchill Court Date Due
Indianapolis, In 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/21/16 2000407006 Refund $ 11.00
Total $ 11.00
I 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
9/21/2016
Receipt407:006 .
Administrative Offices O cher2000407:00:6'
1411 E. 116th Street
Carmel, IN 46032 Se21Zf�16 i2 4q1,PM .
Phone: (317) 843-3875
_FAX:
Ch
Email: info.@carmeiclayparks.com
Carff
,6rks_&' Rreation. .
KAR_ENwOb SER ,
URCal
NATIONALGOLD MEDALMINNER
IWN63iANAPOLIS ISM 46280 {� :� N. .
Prepared:By: niche[iey
Customer_I®: 10139
Primary'phone: (317) 575-1993, Secondary phone: =-
Refund Summary.
Check: ($11:00) Check #
Total Received:-
($11.00) Total Refund: ($11.00)
Transactions'
Custoinner Description item. . Unit : Qty: Fee Charge-
CaleboDeBoer Adaptive Adult Kar-aoke.Night#168034-03.
Activity Fee Each. 1.00
1030.Churchill Court Action:Withdraw
Indianapots,IN 46280 : Withdrawal Date:Sep 21,2016
Primary phone:(317)575-
1993 Meets:August 5,2016
"Email,gkdebder@yah'oo:c0m. Friday"m 6p-to Spm
ID>202 Location: .
Meeting.Room at Monon Community Center East Building.
'Total Charges ($11:00)
otat P dYme '(
$14 NO).
Balance $0
RECEV]ED
SEPI
2 .2016 '.
Y:
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