221200 06/18/2013 i
CITY OF CARMEL, INDIANA VENDOR: 367208 Page 1 of 1
ONE CIVIC SQUARE JAMIE PORTERFIELD CHECK AMOUNT: $568.00
CARMEL, INDIANA 46032 1527 OLD MILL CIRCLE
CARMEL IN 46032 CHECK NUMBER: 221200
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 568 . 00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1063206
armel e Clay Payment Date: 06/11/13
Parks&Recreation Household #: 23576
Monon Community Center Jamie Porterfield Hm Ph: (317)574-4975
Carmel IN 46032 1527 Old Mill Cir. Wk Ph: (317)212-6831
Carmel IN 46032 Cell Ph:(317)501-5985
jamiemporterfield@yahoo.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
The following item reflects a payment towards a previous receipt
Pass Holder: James Porterfield Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Flat May PM (ESEFYP), #203695 202.00 0.00 0.00 202.00 0.00
Valid Dates: 05/06/2013 to 05/29/2013 (Pass Change)
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 568.00
Processed on 06/11/13 @ 15:05:47 by JAB FEES ADJUSTED ON CHANGED ITEMS(+) 0.00
+ `�J NET AMOUNT FROM CHANGED ITEMS 0.00
VHH BALANCE APPLIED TO THIS RECEIPT(+) 568.00-
TOTAL AMOUNT REFUNDED 568.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 568.00 Made By=_>REFUND FINAN With Reference==>check refund
Payment of==> 202.00 Made By=_> Activity Registration Credit Balance
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
Author' Signatur Date Authorized Signature Date
Escape Day Passes are non-refundable.
i � J41VI
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.
Porterfield, Jamie Terms
1527 Old Mill Cir. Date Due
Carmel, IN 46032
Invoice B1063206 Description
Date TRefu;nd r note attached invoice(s) or bill(s)) Amount
6/11/13 $ 5 68.00
I
Total $ 568.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Porterfield, Jamie Allowed 20
1527 Old Mill Cir.
Carmel, IN 46032
In Sum of$
$ 568.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-13 1063206 4358400 $ 568.00 - 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
13-Jun 2013
Signature
$ 568.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund