213856 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 366648 Page 1 of 1
ONE CIVIC SQUARE JILL BIRK
CARMEL, INDIANA 46032 614 BLICKSPORT LANE CHECK AMOUNT: $27.50
WESTFIELD IN 46074 CHECK NUMBER: 213856
CHECK DATE: 10/23/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 27 . 50 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt# 958253
Carmel is Payment Date: 10/12/12
Perks&Recreation Household #: 17807
Monon Community Center Jill Birk Hm Ph: (317)669-7754
Carmel IN 46032 614 Bucksport Ln Wk Ph: (317)846-7721
Westfield IN 46074 Ext. 87161
jbirk @ccs.k12.in.us Cell Ph:(317)371-5303
Phone: (317)848-7275
Fed Tax ID #35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Activity Registration 27.50- 27.50 0.00
PREVIOUS NET HOUSEHOLD BALANCE 27.50
Processed on 10/12/12 @ 09:29:24 by ERM NEW REFUND AMOUNT(-) 27.50
TOTAL REFUNDABLE AMOUNT. 27.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 27.50 Made By==>REFUND FINAN With Reference=_>Check Refund
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.
A/
Authorized Signature Date Authorized Signature Date
(v_'6-lo. qc)eD
Join us at West Park on Saturday, October 6, from 4-9pm, for our Fall Food Festival & Benefit. Local food trucks, restaurants,
and beer/wine vendors compete to be the first ever Fall Food Festival Winner! Try their favorite dishes, relax with the music,
and enjoy a beautiful day at the park with your family. Help children and families participate in department-wide activities;
proceeds will help fund scholarships. $5/person entry fee. There will be an additional cost for food and drink purchases.
Register online at www.carmelclayparks.com.
Escape 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.
Birk, Jill Terms
614 Bucksport Ln Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/12/12 958253 Refund $ 27.50
Total I $ 27.50
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.
Birk, Jill Allowed 20
614 Bucksport Ln
Westfield, IN 46074
In Sum of$
$ 27.50
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-10 958253 4358400 $ 27.50 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
18-Oct 2012
/0 WVXAIV�
Signature
$ 27.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund