221596 07/02/2013 - CITY OF CARMEL, INDIANA VENDOR: 367232 Page 1 of 1
ONE CIVIC SQUARE ROXANNE KOGLER
CARMEL, INDIANA 46032 10141 PARTRIDGE PLACE CHECK AMOUNT: $2,256.00
CARMEL IN 46033
CHECK NUMBER: 221596
CHECK DATE: 7/212013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 1076215 1, 556 . 00 REFUNDS AWARDS & INDE
1082 4358400 1076215 700 . 00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1076215
cif l" e I Q> Clay Payment Date: 06/20/13
J Household ousehold #: 5353
Monon Community Center Roxanne Kogler Hm Ph: (317)844-6159
Carmel IN 46032 ° , ' 10141 Partridge Place Wk Ph: (317)580-4848
Carmel IN 46033 Cell Ph:
Phone: (317)848-7275
JUN 2 1 2013 praz04 @sbcglobal.net
Fed Tax ID #35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Activity Registration 700.00- 700.00 0.00
Module: Pass Management 1,556.00- 1,556.00 0.00
I
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 2,256.00
Processed on 06/20/13 @ 15:54:21 by BJJ NEW REFUND AMOUNT(-) 2,256.00
TOTAL REFUNDABLE AMOUNT 2,256.00-1
NEW NET HOUSEHOLD BALANCE 0.00
Refund of==> 2,256.00 Made By==>REFUND FINAN With Reference=_> 1082-1-4358400 --7� /dgI — 3.S 6Y,90
All refunds are subject to State Board of Accounts procedures and may take 4-6 eks to process. No cash refunds will be
issued. C
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Atize gnature Date Authorized Signature Date
Escape Day Passes are non-refundable.
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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.
Kogler, Roxanne Terms
10141 Partridge Place Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/20/13 1076215 Refund $ 700.00
6/20/13 1076215 Refund $ 1,556.00
I
Total $ 2,256.00
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.
Kogler, Roxanne Allowed 20
10141 Partridge Place
Carmel, IN 46033
In Sum of$
$ 2,256.00 _
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1082-1 1076215 4358400 $ 700.00 1 hereby certify that the attached invoice(s), or
1081-4 1076215 4358400 $ 1,556.00 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
1-Jul 2013
U✓
Signature
$ 2,256.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund