223092 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 367438 Page 1 of 1
ONE CIVIC SQUARE RENITA MOON
CARMEL, INDIANA 46032 13175 CAMILLO CT CHECK AMOUNT: $60.00
? WESTFIELD IN 46074
«o � CHECK NUMBER: 223092
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 60 . 00 PARKS DEPARTMENT REFU
GLOBAL REFUND RECEIPT
Receipt# 1122828
Carmel 0 Clay Payment Date: 08/05/13
Pa.rksAccreation Household #: 20542
AUG - 5 2013
Monon Community Center Renita Moon Hm Ph: (317)344-2061
Carmel IN 46032_. 13175 Camillo Ct Wk Ph: (317)692-7934
Westfield IN 46074 Cell Ph:(574)320-5470
renita.moon @ infarmbureau.com
Phone: (317)848-7275
Fed Tax ID #35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Pass Management 60.00- 60.00 0.00
` PREVIOUS NET CREDIT HOUSEHOLD BALANCE 60.00
Processed on 08/05/13 @ 09:53:20 by BJJ NEW REFUND AMOUNT(-) 60.00
TOTAL REFUNDABLE AMOUNT
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 60.00 Made By=_REFUND FINAN With eference=_>1081-3-4358400
All ref ds are subject to State Board of Account procedures and may take 4-6 weeks to process. No cash refunds will be
issue .
�-S-r3
b�' ed Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
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.
Moon, Renita Terms
13175 Camillo Ct Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
815113 1122828 Refund $ 60.00
Total $ 60.00
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.
Moon, Renita Allowed 20
13175 Camillo Ct
Westfield, IN 46074
n Sum of$
$ 60.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1081-3 1122828 4358400 $ 60.00 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
8-Aug 2013
Signature
$ 60.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund