219901 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 367123 Page 1 of 1
' ONE CIVIC SQUARE KATHLEEN SLAUZIS
CARMEL, INDIANA 46032 4909 ADAMS BLVD N,APT C CHECK AMOUNT: $45.00
INDIANAPOLIS IN 46220 CHECK NUMBER: 219901
CHECK DATE: 5/7/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 1040538 45 . 00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1040538
Carmel 1D lay Payment Date: 04/22/13
y Household #: 33791
ar sAccreatlon
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Monon Community Center athleen Slauzis
Carmel IN 46032 ��� �� a � �j1 Y ` ark D��t'C Wk Ph: (317)848-8710
Carm�� �6(�32_� Cell Ph:(317)410-0601
Phone: (317)848-7275
k Isathleen.slauzis @gmaii.com
Fed Tax ID#35-6000972
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PREVIOUS NET HOUSEHOLD BALANCE 45.00
Processed on 04/22/13 Q 08:40:38 by JAB NEW REFUND AMOUNT() 45.00
TOTAL REFUNDABLE AMOUNT 45.00"
qN� NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 45.00 Made By==>REFUND FINAN With Reference==>check refund
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
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Auth Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
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APR 2 2 2013
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.
Slauzis, Kathleen Terms
4909 Adams Blvd N, Apt C Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/22/13 1040538 Refund $ 45.00
Total $ 45.00
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.
Slauzis, Kathleen Allowed 20
4909 Adams Blvd N, Apt C
Indianapolis, IN 46220
In Sum of$
$ 45.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITLE AMOUNT
1082-03 1040538 4358400 $ 45.00 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
2-May 2013
Signature
$ 45.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund