219318 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 367085 Page 1 of 1
ONE CIVIC SQUARE JILLIAN FRAYER
CARMEL, INDIANA 46032 5880 NORWALDO AVE CHECK AMOUNT: $674.10
-off`o INDIANAPOLIS IN 46220 CHECK NUMBER: 219318
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4358400 674 . 10 REFUNDS AWARDS & INDE
f
FACILITY REFUND RECEIPT
r"b Receipt# 1038956
L-arme) o lay Payment Date: 04/15/13
oaf� s&ReCl eatio 1 Household #: 27730
lonon Community Center Jillian Frayer Hm Ph: (317)
armel IN 46032 CFT'\7F� 5880 Norwaldo Avenue
Indianapolis IN 46220 Cell Ph:
APR 16 2013
hone: (317)848-7275
ed Tax ID #35-6000972 R
BY:
'acility Reservation Details
CANCELLATION - Refund Of 674.10
Facility: Monon Community Cntr, Banquet Room -All 3
Reserv.Contact: Jillian Frayer
Reserv.Number: 23600 Status: Cancelled
Purpose: Jillian Frayer Wedding Reception (RCC)
Anticipated Count: 150
Date Day Time Fees+Tax Discount Prev Paid Cur Paid Amount Due
10/11/2014 Sat 6:OOP to 12:OOA 0.00 0.00 0.00 0.00 0.00
Cancel Reason: MCC no longer has event space.
PREVIOUS NET HOUSEHOLD BALANCE 674.10
Processed on 04/15/13 @ 13:10:10 by CLL FEES CHANGED ON CANCELLED ITEMS(+) 1,260.00-
SALES TAX CHARGED ON CANCELLED FEES(+) 88.20-
NET AMOUNT FROM CANCELLED ITEMS 1,348.20-
HH BALANCE APPLIED TO THIS RECEIPT(+) 674.10
TOTAL AMOUNT REFUNDED 674.10
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 674.10 Made By==>REFUND FINAN With Reference=_>Check
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
The count for this line item will not be known until after the reservation date. Therefore, both the count and the extension are
left at zero for reservation purposes, but will be updated after the reservation date. As soon as this data is available, you will
be invoiced for the cu rre amount due. Please remit to our office within 10 days of the invoice date.
C
A thonzed Signatu�e� Date' ' uthorized Signature Date
Escape Day Passes are non-refundable. 1 001 C5 . 3L l[uo2.®
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.
Frayer, Jillian Terms
5880 Norwaldo Avenue Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number
or note attached invoices) or bill(s)) Amount
4115113 1038956 Refund $ 674.10
I
Total $ 674.10
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.
Frayer, Jillian Allowed 20
5880 Norwaldo Avenue
Indianapolis, IN 46220
In Sum of$
$ 674.10
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1095-3 1038956 4358400 $ 674.10 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
19-Apr 2013
Signature
$ 674.10 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund