188302 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 364496 Page 1 of 1
ONE CIVIC SQUARE EMMANUEL DELAHAYE
CARMEL, INDIANA 46032 10336 RANDALL DRIVE CHECK AMOUNT: $190.00
CARMEL IN 46033
CHECK NUMBER: 188302
CHECK DATE: 813!2016
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4356400 481889 190.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 481889
Payment Date: 07/22/10
Household 24120
Monon Community Center Emmanuel Delahaye Hm Ph: (317)564 -4472
Carmel IN 46032 10336 Randall Dr Wk Ph: (765)741 -7134
Carmel IN 46033 Cell Ph: (765)212 -6830
rdelahaye @droledider.fr
Phone: (317)848 -7275
Fed Tax ID 435- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 190.00
Pass Holder: Emmanuel Delahaye Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH Mthly (M MCHHM), #83101 736.00 0.00 736.00 0.00 0.00
Valid Dates: 10/0 1 /2009 to 10/0112010 Pass Change)
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/22/10 09.45.33 by TLP FEES ADJUSTED ON CHANGED ITEMS 190.00
NET AMOUNT FROM CHANGED ITEMS 190.00-
TOTAL AMOUNT REFUNDED 190.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 190.00 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 c sh or credit card refunds.
7 Z-/
Authorized Signature D to Authorized Signature Date
Enjoy your escape at the MCC.
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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.
Delahaye, Emmanuel Terms
10336 Randall Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/22/10 481889 Refund 190.00
Total 190.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Delahaye, Emmanuel Allowed 20
10336 Randall Dr
Carmel, IN 46033
In Sum of
190.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 481889 4358400 190.00 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
29 -Jul 2010
'IYUyI lPi�
Signature
190.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund