189818 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 364698 Page 1 of 1
ONE CIVIC SQUARE SHANE HARTKE
CARMEL, INDIANA 46032 11880 SALENNE COURT CHECK AMOUNT: $84.00
CARMEL IN 46032
CHECK NUMBER: 189818
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 84.00 PARKS DEPT REFUND
PASS REFUND RECEIPT
Receipt 514524
Payment Date: 08/30/2010
Household 29466
Home Phone: (317)946 -3356
SHANE HARTKE Monon Community Center
11880 SALENNE COURT Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Orig Bal Refund New Bal
Module: Pass Management 84.00- 84.00 0.00
PREVIOUS NET HOUSEHOLD BALANCE 84.00
Processed on 08/30/10 15:20:32 by CRIB NEW REFUND AMOUNT 84.00
TOTAL REFUNDABLE AMOUNT _84'.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 84.00 Made By REFUND FINAN With Reference Account Error
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 or credit card refunds.
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Authorized Signature date I Authorized Signature Date
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Don't forget to register for St.Vincent Tour de Carmel taking place on Saturday, September 11. Visit
www.carmelclayparks.com for more information or https: /rec.themononcenter.com/ to register!
If you have already registered for the event, you may pick up your goodie bag at the MCC East Building on September 7 from
5 -8pm, September 8 from 9am -1 pm, or September 9 from 5 -8pm.
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Stu 0 2010
BY:
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.
Hartke, Shane Terms
11880 Salenne Court Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8130110 514524 Refund 84.00
Total 84.00
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.
Hartke, Shane Allowed 20
11880 Salenne Court
Carmel, IN 46032
In Sum of
84.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT /TITLE AMOUNT Board Members
Dept
1092 514524 4358400 84.00 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
9 -Sep 2010
Signature
84.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund