187206 07/07/2010 CITY OF CARMEL, INDIANA VENDOR: 361946 Page 1 of 1
ONE CIVIC SQUARE RICK ACOSTA
CARMEL, INDIANA 46032 12871 FLEETWOOD DRIVE s CHECK AMOUNT: $84.00
CARMEL IN 46032
CHECK NUMBER: 187206
CHECK DATE: 7/7/2010
DEPARTMENT ACCOUNT PO NUMBER INV OICE NUMBER AMOUNT DESCRIPTION
1092 4358400 451947 84.00 REFUNDS AWARDS INDE
.-v
GLOBAL REFUND RECEIPT
Receipt 451947
Payment Date: 06/24/10
Household 2752
Carmel Clay Parks Recreation Rick Acosta Hm Ph: (317 )844 -2343
1235 Central Park Drive East 12871 Fleetwood Drive South
Carmel IN 46032 Carmel IN 46032 Cell Ph: (317)490 -6469
racosta @indy.rr.com
_Fj�none: (317 )848 -7275
Fed Tax ID #35- 6000972
Refund Details
Ono Bal Refund New Bal
Module: Pass Management 84.00- 84.00 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 84.00
Processed on 06/24/10 12:07;49 by ABK NEW REFUND AMOUNT 84.00
TOTAL REFUNDABLE AMOUNT 84.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 84.00 Made By REFUND FiNAN With Reference Chged to Corp Pass
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 cashge credit card refunds.
Authorized Sigrtatur Dale Authorized Signature Date
(2-X Y-0
Page 4 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.
Acosta, Rick Terms
12871 Fleetwood Drive South Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6124110 451947 Refund 84.00
Total 84.00
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.
Acosta, Rick Allowed 20
12871 Fleetwood Drive South
Carmel, IN 46032
In Sum of
84.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 451947 4358400 84.00 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
1 -Jul 2010
q&xwk'
Signature
84.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund