220672 06/04/2013 CITY OF CARMEL, INDIANA VENDOR: 367199 Page 1 of 1
ONE CIVIC SQUARE RAVI JAYANNA
}' CARMEL, INDIANA 46032 221 E MAIN ST CHECK AMOUNT: $143.00
CARMEL IN 46032
CHECK NUMBER: 220672
CHECK DATE: 6/4/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 143 . 00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Carmel a Receipt# 1055970
Clay Payment Date: 05/30/13
Parks&&lose lon Household #: 38470
Monon Community Center Ravi Jayanna
Carmel IN 46032 221 E. Main St.
Carmel IN 46032 Cell Ph:(317)603-9397
Phone: (317)848-7275 reach deeps @ hotmail.com
Fed Tax ID #35-6000972
Refund Details
Orig Bal Refund New Bal
Module: Pass Management 143.00- 143.00 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 143.00
Processed on 05/30/13 @ 14:28:40 by BJJ NEW REFUND AMOUNT(-) 143.00
TOTAL REFUNDABLE AMOUNT_ 143.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 143.00 Made By==>REFUND FINAN With Refer(.e f==> 081-10-4358400
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
thori ignature Date Authorized Signature Date
Escape Day Passes are non-refundable.
ET17
tp
LTAT >
J :NO 3 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.
Jayanna, Ravi Terms
221 E Main ST Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/30/13 1055970 Refund $ 143 00
Total $ 143.00
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.
Jayanna, Ravi Allowed 20
221 E Main ST
Carmel, IN 46032
In Sum of$
$ 143.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#!TITLE AMOUNT Board Members
Dept#
1081-10 1055970 4358400 $ 143.00 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
3-Jun 2013
Sign ture
$ 143.00 Accounts Payable Coordinator
Cost distribution lodger classification if Title
claim paid motor vehicle highway fund