187678 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 364467 Page 1 of 1
ONE CIVIC SQUARE DAVE ADAMS CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 7554 DAYBREAK CIRCLE
FISHERS IN 46038 CHECK NUMBER: 187678
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239099 100.00 REFUND
sRE C
o
Mr. Dave Adams paid $100 to play in the Inaugural City Golf Championship a month prior to the
event. He had a death in the family and had to attend a funeral the same weekend as the City
Championship. Our staff was informed of Dave Adams situation a couple of days before the event. I
would like to return $100 to Dave Adams.
His home address is
Dave Adams
7554 Daybreak Cir
Fishers, IN 46038
Brian Ballard
S (I- z
PGA Head Golf Professional
Brookshire Golf Club
V N O. WARRANT NO.
ave Adams ALLOWED 20
_D
IN SUM OF
7554 Daybreak Circle
Fishers, IN 46038
$100.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO Dept. INVOICE NO, ACCT #(TITLE AMOUNT Board Members
1207 DADAMS 42- 390.99 $100.00 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
Tuesday, July 06, 2010
Director, Brookshir Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
07/06/10 DADAMS Refund Championship Fee $100.00
I 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