HomeMy WebLinkAbout225011 10/08/2013 F CITY OF CARMEL, INDIANA VENDOR: 367647 Page 1 of 1
ti ONE CIVIC SQUARE DANA MUSAPATIKA CHECK AMOUNT: $456.00
CARMEL, INDIANA 46032 6843 CEDAR MILL WAY
INDIANAPOLIS IN 46237 CHECK NUMBER: 225011
CHECK DATE: 10/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 456 . 00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1156474
a ; e! lay Payment Date: 10/03/13
Parks&Recreation C,1
Household #: 52849
IRFnrT 0 4 213
Monon Community Center Dana Musapatika Hm Ph: (317)402-7077
Carmel IN 46032 BY 6843 Cedar Mill Way Wk Ph: (317)402-7079
--_kianapolis IN 46237 Cell Ph.-(317)402-7077
Phone: (317)848-7275 dmusapatika@gmail.com
Fed Tax ID #35-6000972
Refund Details
Oria Bat Refund New Bat
Module: Pass Management 456.00- 456.00 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 456.00
Processed on 10/03/13 @ 15:57:12 by BJJ NEW REFUND AMOUNT(-) 456.00
TOTAL REFUNDABLE AMOUNT 456,007
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 456.00 Made By==>REFUND FINAN With Reference=_>1081-8-4358400
C.
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
uth d Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
L,v
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.
Musapatika, Dana Terms
6843 Cedar Mill Way Date Due
Indianapolis, IN 46237
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/3/13 1156474 Refund $ 456.00
Total $ 456.00
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.
Musapatika, Dana Allowed 20
6843 Cedar Mill Way
Indianapolis, IN 46237
In Sum of$
$ 456.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-08 1156474 4358400 $ 456.00 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
4-Oct 2013
Signature
$ 456.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund