210916 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 366417 Page 1 of 1
ONE CIVIC SQUARE MICHAEL KELLAMS
CHECK AMOUNT: $133.00
CARMEL, INDIANA 46032 4991 DEER RIDGE DRIVE S
.o� CARMEL IN 46033 CHECK NUMBER: 210916
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 886088 133 . 00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 886088
armel o Clay Payment Date: 07/06/12
Household#: 36654
Parks&Recreation
RECEIVED
Monon Community Center micheal kellams Hm Ph: (317)843-0693
Carmel IN 46032 JUL 09 2012 4991 Deer Ridge Drive S Wk Ph: (317)338-2162
Carmel IN 46033 Cell Ph:(317)750-4466
Phone: (317)848-7275
BY. kellams5 @att.net
Fed Tax ID#35-6000972
Refund Details
Orio Bal Refund New Bal
Module: Activity Registration 132.00- 132.00 0.00
Module: Pass Management 1.00- 1.00 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 133.00
Processed on 07!06/12 @ 08:35:23 by BJJ NEW REFUND AMOUNT(-) 133.00
TOTAL REFUNDABLE AMOUNT 133.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 133.00 Made By==>REFUND FINAN With Reference==> 1082-4-4358400 I`� '�_�)
All refunds are subject to State Board of Accounts claim procedure and may take 4-6 weeks to process. A check will be
issued. N cash or credit card refunds.
Aut b5 ign ature Date Authorized Signature Date
Volunteer with Us!
Volunteers are the foundation of Carmel Clay Parks & Recreation and we need your help! We are currently seeking volunteers
for special events, adaptive programs, parks and greenways, and Extended School Enrichment. If interested, please call Dana
at 317.843.3868 or register online at https://2011 cpry.theregistrationsystem.com/en/1033!
DAY PASSES ARE NON-REFUNDABLE
Page# 1 of 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.
Kellams, Micheal Terms
4991 Deer Ridge Drive S Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/6112 886088 Refund $ 133.00
Total $ 133.00
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.
Kellams, Micheal Allowed 20
4991 Deer Ridge Drive S
Carmel, IN 46033
In Sum of$
$ 133.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-4 886088 4358400 $ 133.00 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-Jul 2012
Signature
$ 133.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund