219543 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 367086 Page 1 of 1
ONE CIVIC SQUARE LI XIE
CARMEL, INDIANA 46032 14075 MISSISSINEWA DRIVE CHECK AMOUNT: $168.00
�+ CARMEL IN 46033 CHECK NUMBER: 219543
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 168 . 00 REFUNDS AWARDS & INDE
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001028375.TXT sr
smoky Row Elementary Clerk: LKW y
Date: 03/26/2013 Time: 09:05:12
H/H: Li Xie
F/M: Claire Qu L; )Cleo
Description Ext Price t Lkn5 µ15SIS5l W��DR
---------------------------- ---------- C!.A�Rrn�1., t N 4too"33
Class: 476001-07(ENROLLED)
Play on 7.00
Class Dates: 07/15/2013 - 07/19/2013
Class Times: 7:OOA - 6:OOP
Meeting Days: M,Tu,w,Th,F
Class Location:
Clay Middle school
Clay Middle School
5150 East 126th Street
Carmel , IN 46033
Rcpt# 1028375 Prev Bal : 0.00
New charges 168.00- 7
New Tax: 0.00 '
Total Due: 168.00-
Tot Refund: 168.00 1 "
1 �
New Bal : 0.00
Refund Type: Refund from Finance
REFUN FINAN Refund of: 168.00 _
r7��� .r .; _ X77
-- ------- ------------- ------------ APR 19 2013
u ized signature Date
------------------------- ------------
Authorized signature Date
All refunds are subject to state Board
of Accounts procedures and may take 4-6
weeks to process. No cash refunds
will be issued.
Fed Tax ID #35-6000972
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Page 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.
Xie, Li Terms
14075 Mississinewa Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/26/13 1028375 Refund $ 168.00
Total $ 168.00
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.
Xie, Li Allowed 20
14075 Mississinewa Dr
Carmel, IN 46033
In Sum of$
$ 168.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-11 1028375 4358400 $ 168.00 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
18-Apr 2013
Signature
$ 168.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund