208773 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 366232 Page 1 of 1
ONE CIVIC SQUARE JIM KORNMANN CHECK AMOUNT: $2,175.00
CARMEL, INDIANA 46032 5264 PURSEL LANE
CARMEL IN 46033 CHECK NUMBER: 208773
CHECK DATE: 5/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 REFUND 2,175.00 MEMBERSHIP REFUND
RECEIPT REPRINT"
Brookshire Golf Club
12120 Brookshire Pkwy
Carmel, IN 46033
Ph:(317)846 -7431
Monday, January 23, 2012 9:56:15 AM
RECEIPT #:142956 User:Proshopl
Jim Kornmann
Item
Description
Qty Price Total
1393
Season Pass (senior Couple) Carmel Resident
1 $1,850.00 $1,850.00
1406
Season Pass (returning Holder) Discount
1 ($75.00) ($75.00)
1006
Gift Card Issued
XXXX XXXX XXXX- 9649.Ref:4030
1 $100.00 $100.00
1006
Gift Card Issued
XXXX XXXX -XXXX -9656 Ref:4031
1r $100.00 $100.00
1397
Season Pass (cart Pass) Carmel Resident
2 $100.00 $200.00
Grand Total: $2,175.00
**Visa: $2,175.00
Change: $0.00
Credit Card #:xxxx -xxxx -xxxx -3701
Approval Code:00344C UQ :XX /XX
Reference #.:4093,
Thank you for playing Brookshire Golf Club!!
In case of severe weather or lighting, play at
your own risk!
NOW BOOK ONLINE www.brookshii
11 11 Iii 11111 X111 II 1II
Community Heart and Vascular Physicians -North
8075 North Shadeland Avenue Suite 200 Indianapolis, IN 46250
317- 621 -8500 Fax: 317- 621 -8501
April 24, 2012
Regarding: JAMES KORNMANN
10/22/1936
To Whom it May Concern:
I have been seeing Mr. Kornmann regularly for some new cardiac issues this spring. He will be unlikely to
utilize his season membership at Brookshire Golf Club this year due to these cardiac issues. Please take
this into consideration and call me if there are any questions /concerns in this regard.
Sincerely,
Michael Robertson MD
f;
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/24/12 Membership Refund $2,175.00
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
1 20
Clerk- Treasurer
VOUCHE NO. WAR RANT NO.
ALLOWED 20
Jim Kornmann
IN SUM OF
5264 Pursel Lane
Carmel, IN 46033
$2,175.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
I 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
Tuesday, May 01, 2012
Director, Brooks re Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund