189023 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 364551 Page 1 of 1
ONE CIVIC SQUARE YASUSHI TABITA
I CARMEL, INDIANA 46032 12640 WINDHAM PASS CHECK AMOUNT: $20.00
'a CARMEL IN 46032 CHECK NUMBER: 189023
CHECK DATE: 8/18/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 492121 20.00 REFUNDS AWARDS INDE
GLOBAL REFUND RECEIPT
Receipt 492121
Payment Date: 08/02/10
Household 34933
Monon Community Center Yasushi Tabita Hm Ph: (317)663 -7219
Carmel IN 46032 12640 Windham Pass
Carmel IN 46032 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Ong Bal Refund New Bal
Module: Activity Registration 20.00- 20.00 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 20.00
Processed on 08/02/10 09:46:01 by TL NEW REFUND AMOUNT 20.00
TOTAL REFUNDABLE AMOUNT 20.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 20.00 Made By REFUND FINAN With Referonce event was cancelled; family fs�
All refunds are subject to "Sta a Board o c o nts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No 'or credit car refund
uthorized Signat r Date Authorized Signature Date
Enjoy your escape at the MCC.
1� U
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.
Tabita, Yasushi Terms
12640 Windham pass Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
812!10 492121 Refund 20.00
Total 20.00
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.
Tabita, Yasushi Allowed 20
12640 Windham pass
Carmel, IN 46032
In Sum of
20.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #ITITLE AMOUNT Board Members
Dept
1096 -60 492121 4358400 20.00 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
12 -Aug 2010
Signature
20.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund