184226 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 364043 Page 1 of 1
ONE CIVIC SQUARE RAINA CHEZEM
CHECK AMOUNT: $220.00
CARMEL, INDIANA 46032 5694 BLACKFOOT TRAIL
`o CARMEL IN 46033 CHECK NUMBER: 184226
CHECK DATE: 4/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 406351 220.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 406351
Payment Date: 04/02/10
Household 5130
Monon Center Raina Chezem Hm Ph: (317)818 -9936
Carmel IN 46032 5694 Blackfoot Trail Wk Ph: (317)844 -3421
Carmel IN 46033 Cell Ph: (317)440-8478
raina.chezem @nelnet.net
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Oric Bal Refund New Bal
Module: Pass Management 220.00- 220.00 0.00
G/L Code Description Accoun Number Cst Cntr Descripti Account Number A mount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 220.00 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 HOUSEHOLD BALANCE 220.00
Processed on 04/02/10 14:56:13 by JAB NEW REFUND AMOUNT(-) 220.00
TOTAL REFUNDABLE AMOUNT 220.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 220.00 Made By REFUND FINAN With Reference
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 ca h or credit car refunds.
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A rized igna re Date Authorized Signature }Date
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APB; G 5 2010
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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.
Chezem, Raina Terms
5694 Blackfoot Trail Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
412110 406351 Refund 220.00
Total 220.00
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.
Chezem, Raina Allowed 20
5694 Blackfoot Trail
Carmel, IN 46033
In Sum of
220.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -7 406351 4358400 220.00 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
8 -Apr 2010
Signature
220.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund