220584 06/04/2013 CITY OF CARMEL, INDIANA VENDOR: 367196 Page 1 of 1
ONE CIVIC SQUARE STEVE ELNSER CHECK AMOUNT: $674.10
CARMEL, INDIANA 46032 12463 GLENDURGEN DR
�? CARMEL IN 46032
CHECK NUMBER: 220584
CHECK DATE: 6/4/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4358400 1053048 674 . 10 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
r"+ Receipt# 1053048
L—arm I' {�- Payment Date: 05/22/13
Household #: 47694
lonon Community Center Steve Elsner Hm Ph: (317)848-4062
armel IN 46032 12463 Glendurgen Dr. Wk Ph: (317) -
Carmel IN 46032 Cell Ph:(317)850-9573
hone: (317)848-7275 seelsner @yahoo.com
ed Tax ID #35-6000972
refund Details
Orio Bal Refund New Bal
Module: Facility Reservation 674.10- - 674.10 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 674.10
Processed on 05/22/13 @ 11:56:20 by CLL NEW REFUND AMOUNT(-) 674.10
TOTAL REFUNDABLE AMOUNT 674.10
1095 — 3- : , 1 u ozq NEW NET HOUSEHOLD BALANCE 0.00
Refund of==> 674.10 Made By==>REFUND FINAN With Reference==>CR Balance
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
Authorized Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
Page# 1 of 1
i
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.
Elsner, Steve Terms
12463 Glendurgen Dr Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5122113 1053048 Refund $ 674.10
Total $ 674.10
I 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.
Elsner, Steve Allowed 20
12463 Glendurgen Dr
Carmel, IN 46032
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 1053048 4358400 $ 674.10 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
30-May 2013
Signature
$ 674.10 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund