183156 03/16/2010 a CITY OF CARMEL, INDIANA VENDOR: 363955 Page 1 of 1
ONE CIVIC SQUARE MASAHIKO KUSHIDA CHECK AMOUNT: $60.00
CARMEL, INDIANA 46032 1407 SHADOW RIDGE ROAD
off `o INDIANAPOLIS IN 46280 CHECK NUMBER: 183156
CHECK DATE: 3/16/2010
DEPARTMENT ACCOUNT PO N UMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 390508 60.00 REFUNDS AWARDS INDE
000390508
O @DOry &OOO!O
Monon Center Clerk: RDG
Date: 02/18/2010 Time: 06:07:08
H /H: Masahiko Kushida
F /M: Naoko Kushida i 3 l 1-7
Description Ext Price
Pass 0 Type 15.00
KZ 50 visit 1 t
From 10/16/2009 12/31/2099 40
I 1
Rcpt# 390508 Prev Bal 0.00
New Charges 60.00
New Tax: 0.00
Total Due: 60.00
Tot Refund: 60.00
New Bal: 0.00
Refund Type: Refund from Finance
REFUND FINAN Refund of: 60.00
All refunds are subject to state Board
of Accounts claim procedure and may take
4 -6 weeks to process. A check will be
issued. No cash or credit card refunds.
w
-I-- ICS
Authorize ignature Date
Aut orized signature Date
Fed Tax ID #35- 6000972
N
Rcpt# 390508
D
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Q 2010
O BY
pro (a i2zq L) es Page 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.
Kushida, Masahiko Terms
1407 Shadow Ridge Rd Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)) Amount
2/18/10 390508 Refund 60.00
Total 60.00
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.
Kushida, Masahiko Allowed 20
1407 Shadow Ridge Rd
Indianapolis, IN 46280
In Sum of
60.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -41 390508 4358400 60.00 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
11 -Mar 2010
Signature
60.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund