313669 7/18/2017 1+or C.1�*'
�;; ;� CITY OF CARMEL, INDIANA VENDOR: 371802
ONE CIVIC SQUARE DOMINIQUE WILLIAM CHECK AMOUNT: $********63.00*
?�?4 CARMEL, INDIANA 46032 9305 WITTFIELDCT CHECK NUMBER: 313669
9 INDIANAPOLIS IN 46235 CHECK DATE: 07/18/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 2000689006 63.00 REFUNDS AWARDS & INDE
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.
William, Dominique Terms
9305 Wittsield Ct
Indianapolis, IN 46235
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
7/4/17 2000689006 Refund $ 63.00
Total is 63.00
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
Administrative Offices ;._ �' `'�` Voucher #2000689.006
1411 E. 116th Street
Carmel, IN 46032 - Jul_ 1 ) 2011 Jul 4, 2017 9:53 AM
Phone: (317) 848-7275
FAX: -- BY: ...
Email: info@carmelclayparks.c6M - Car el * Clay
Parks&Recreation
DOMINIQUE WILLIAM NATIONAL GOLD MEDAL WINNER
9305 WITTSIELD CT
INDIANAPOLIS, IN 46235 AND ACCREDITED AGENCY
Prepared By: jordanh
Customer ID: 62535
Primary phone: (317) 417-4874, Secondary phone: --
-
Refund Su--- irt�ary - --
r�------- -- - ---- -----
Check: ($63.00) Check #
Total Received: ($63.00) Total Refund: ($63.00)
-- --- ------------------------
Transactions
Customer Description Jterrx Unit Qty Fee Charge
Dedrion Williams Crouching Tiger Cubs #175001-02 Activity Each 1.00 $63.00 ($63.00)
9305 wittsield ct Action:Withdraw Fee
Indianapolis,IN 46235 Withdrawal Date: Jul 4,2017
Primary phone:(317)417-
4874 Meets: From July 5, 2017 to July 26, 2017
Email: Each Wednesday from 9:30am to loam
dm.williams94@gmail.com Location:
ID:62536 Multipurpose Room East C at Monon Community Center East Building
Total Charges ($63.00)
Total Payments ($63.00)
Balance $0
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7/6/7