181656 01/20/2010 CITY OF CARMEL, INDIANA VENDOR: 363799 Page 1 of 1
d. ONE CIVIC SQUARE BOLF STACY CHECK AMOUNT: $192.88
1 ,o CARMEL, INDIANA 46032 13975 S CYPRESS COVE CIRCLE
;,.,00 FT LAUDERDALE FL 33325 CHECK NUMBER: 181656
CHECK DATE: 1/20/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 374301 192.88 REFUNDS AWARDS INDE
0
GLOBAL REFUND RECEIPT
Receipt 374301
Payment Date: 01/12/10
Household 15386
Monon Center Stacy Bolf Hm Ph: (317)640 -5012
Carmel IN 46032 50 Floren reet bV Wk Ph: (317)
Car 46032 Cell Ph: (317)
stacy-bolf@gmail.com,stacy.bolf@gmail.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Orict Bal Refund New Bal
Module: Pass Management 192.88- 192.88 0.00
G/L Code Description Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 192.88 DR
Finance will have to DEBIT the CONTROL account for the amounts listed above after the checks have been written to the customers.
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 192.88
Processed on 01/12/10 16:31:08 by TLP NEW REFUND AMOUNT 192.88
4 Al I TOTAL REFUNDABLE AMOUNT 192.88 0
NEW NET HOUSEHOLD BALANCE 0.00
R of 192.88 Made f17 REF IND FINAN With Reference_ car to new address
Ali e z e 31;b ect ;•u St ;Le Be. d of Accoun s claim procedure and may take 4 -6 weeks to process. A check will be
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is JAN I42010
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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.
Bolt, Stacy Terms
13975 S Cypress Cove Circle Date Due
Fort Lauderdale, FL 33325
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1112/10 374301 Refund 192.88I
Total 192.88
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
Voucher No. Warrant No.
Bolf, Stacy Allowed 20
13975 S Cypress Cove Circle
Fort Lauderdale, FL 33325
In Surn of
192.88
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or Board Members
INVOICE NO. ACCT #FrITLE AMOUNT
Dept
1092 374301 4358400 192.88 I 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
14 -Jan 2010
1 �e ?//J;
Signature
192.88 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund