188770 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 364529 Page 1 of 1
ONE CIVIC SQUARE BRYCE CROCKER
CARMEL, INDIANA 46032 2520 E COPPER TREE WAY CHECK AMOUNT: $192.04
CARMEL IN 46033
CHECK NUMBER: 188770
CHECK DATE: 8/1812010
DEPARTMEN ACCOUNT P N UMBE R INVOI NUMBER A MOUNT DESCRIPTION
1092 4358400 495462 192.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 495462
Payment Date: 08/05/10
Household 19984
Carmel Clay Parks Recreation 13YZ C C�I—E7Z Hm Ph: (317)581 -1221
1235 Central Park Drive East
Carmel IN 46032 a ate 0P� T✓--e i.JAY Cell Ph.
Phone: (317)848 -7275 34r`�'
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 192.00
Pass Holder: Clay Crocker Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Adlt Mthly (M MCAM), #29617 0.00 0.00 0.00 0.00 0.00
Valid Dates: 06/28/2009 to 07/01/2010 Pass Cancellation)
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/05/10 13:08:53 by ABK FEES ADJUSTED ON CHANGED ITEMS 192.00-
?NETAMOUNT`FROM'CHANGED ITEMS 192:00
TOTAL AMOUNT REFUNDED 192.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 192.00 Made By REFUND FINAN With Reference Bryce Crocker
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 r credit card refunds.
Authoriz Signature Datd Authorized Signature Date
ENJOY YOUR ESCAPE!
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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.
Crocker, Bryce Terms
2520 E Copper Tree Way Date Due
Carmel, 1N 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
815!10 495462 Refund 192.00
Total 192.00
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,
Crocker, Bryce Allowed 20
2520 E Copper Tree Way
Carmel, IN 46033
In Sum of
192.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 495462 4358400 192.00 1 hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
12 -Aug 2010
y2x &pmzm.
Signature
192.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund