211490 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 366432 Page 1 of 1
ONE CIVIC SQUARE ILANA TORINE
CARMEL, INDIANA 46032 335 FAIRHAVEN ROAD CHECK AMOUNT: $77.00
FAIRHAVEN NJ 07704
CHECK NUMBER: 211490
CHECK DATE: 7131/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 906263 77 . 00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 906263
of miss @ Clay Payment Date: 07/18/12
Irks&Recreation Household #: 21021
Monon Community Center `�A" Ilana Torine Hm Ph: (317)581-9954
Carmel IN 46032 3�j Vl av 14035 Hone rive Wk Ph: ( 31)727-4477
Car 46032 Cell Ph:(317)428-8348
i Y
Phone: (317)848-7275 V kvf w ) N J rine @iupui.edu
Fed Tax ID#35-6000972 u
Refund Details
Oria Bal Refund New Bal
Module: Pass Management 77.00- 77.00 0.00
PREVIOUS NET HOUSEHOLD BALANCE 77.00
Processed on 07/18/12 @ 14:40:21 by JAB NEW REFUND AMOUNT(-) 77.00
TOTAL REFUNDABLE AMOUNT 77.00
u 1 V e1/ NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 77.00 Made By=_>REFUND FINAN With Reference=_>check refund
unds are subject to State Board of Accounts claim procedure and may take 4-6 weeks to process. A check will be
issue . No cash or credit card refunds.
Authori e Signature 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:H2011 cprv.theregistrationsystem.com/en/1033!
DAY PASSES ARE NON-REFUNDABLE
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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.
Torine, Ilana Terms
335 Fairhaven Rd Date Due
Fairhaven, NJ 07704
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)) Amount
7/18112 906263 Refund $ 77.00
Total $ 77.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Torine, Ilana Allowed 20
335 Fairhaven Rd
Fairhaven, NJ 07704
In Sum of$
$ 77.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-03 906263 4358400 $ 77.00 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
26-Jul 2012
Signature
$ 77.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund