224702 09/25/2013 _ CITY OF CARMEL, INDIANA VENDOR: 367625 Page 1 of 1
ONE CIVIC SQUARE XUKAI ZOU CHECK AMOUNT: $78.00
„o CARMEL, INDIANA 46032 5742 FAIRBOURNE CT
CARMEL IN 46033 CHECK NUMBER: 224702
CHECK DATE: 9/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 1146079 78 . 00 PARKS DEPARTMENT REFU
GLOBAL REFUND RECEIPT
Receipt# 1146079
CaTme`I Payment Date: 09/06/13
Household #: 10821
SEP 10 2013
Monon Community Center Xukai Zou Hm Ph: (317)815-8128
Carmel IN 46032 BY: 5742 Fairbourne Ct. Wk Ph: (317)278-8576
Carmel IN 46033 Cell Ph:(317)270-2933
xkzou @cs.iupui.edu
Phone: (317)848-7275
Fed Tax ID #35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Pass Management 78.00- 78.00 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 78.00
Processed on 09/06/13 @ 16:20:37 by BJJ NEW REFUND AMOUNT(-) 78.00
TOTAL REFUNDABLE AMOUNT' 78:00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 78.00 Made By==>REFUND FINAN With Reference=_>1081-11-4358400 ti�)
All refundp are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
tho d Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
"Aic �3C
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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.
Zou, Xukai Terms
5742 Fairbourne Ct Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/6/13 1146079 Refund $ 78.00
Total $ 78.00
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
, 20
Clerk-Treasurer
Voucher No. Warrant No.
Zou, Xukai Allowed 20
5742 Fairbourne Ct
Carmel, IN 46033
In Sum of$
$ 78.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-11 1146079 4358400 $ 78.00 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
19-Sep 2013
vAk���
Signature
$ 78.00 _ Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund