188887 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 364538 Page 1 of 1
ONE CIVIC SQUARE STAN KWIATKOWSKI CHECK AMOUNT: $52.00
CARMEL, INDIANA 46032 749 SUFFOLK LANE
CARMEL IN 46032 CHECK NUMBER: 188887
CHECK DATE: 8/18/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 501788 52.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 501788
Payment Date: 08/10/10
Household 34326
Monon Community Center Stan Kwiatkowski Hm Ph: (317)844 -3611
Carmen IN 46032 749 Suffolk Lane
Carmel IN 46032 Cell Ph:
stan.kwiatkowski@yahoo.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Oria Bal Refund New Bal
Module: Activity Registration 52.00- 52.00 0.00
PREVIOUS NET HOUSEHOLD BALANCE 52.00
Processed on 08/10/10 13:18:21 by MML NEW REFUND AMOUNT 52.00
TOTAL REFUNDABLE AMOUNT 52.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 52.00 Made By REFUND FINAN With Reference low enrollment wado
All refunds are subject to State Board of Accounts claim procedure and may take eks to process. A check will be
issuQr redit card refunds.
/zn 4 r 6 /tG Q to horize Signatu Date
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ENJOY YOUR ESCAPE!
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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.
Kwiatkowski, Stan Terms
749 Suffolk Lane Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8110110 501788 Refund 52.00
Total 52.00
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.
Kwiatkowski, Stan Allowed 20
749 Suffolk Lane
Carmel, IN 46032
In Sum of
52.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE N0. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -50 501788 4358400 52.00 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
52.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund