189411 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 364640 Page 1 of 1
ONE CIVIC SQUARE BEATA KUPILAS
CARMEL, INDIANA 46032
3848 MEADOWSIDE COURT CHECK AMOUNT: $270.00
oM �e ZIONSVILLE IN 46077 CHECK NUMBER: 189411
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 270.00 PARKS DEPARTMENT REFU
GLOBAL REFUND RECEIPT
Receipt 508447
Payment Date: 08/18/10
Household 2956
Monon Community Center Beata Kupilas Hm Ph: (317)873 -9351
Carmel IN 46032 3848 Meadowside Ct Wk Ph: (317)848 -2998
Zionsville IN 46077 Cell Ph: 317)460 -8186
beatokupilas @yahoo.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Ong Bal Refund_ New Bal
Module: Pass Management 270.00- 270.00 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALAI4CE 270.00
Processed on 08116/10 13:04:33 by BJJ NEW REFUND AMOUNT 270.00
TOTAL REFUNDABLE AMOUNT 270.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 270.00 Made By =a REFUND FINAN With Reference
All refunds re subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No` ash or credit card refunds.
Aul orized nature Dale Authorized Signature Date
-M
ENJOY YOUR ESCAPE!!!
AUG P.62010
J� BY...
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Page 1
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Kupilas, Beata Terms
3848 Meadowside Ct Date Due
Zionsville, IN 46077
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8116110 508447 Refund 270.00
Total 270.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Kupilas, Beata Allowed 20
3848 Meadowside Ct
Zionsville, IN 46077
In Sum of$
270.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept
1081 -9 508447 4358400 270.00 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
A�ljn 7 0 1 0
Signature
270.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund