225814 11/05/2013 CITY OF CARMEL, INDIANA VENDOR: 367723 Page 1 of 1
ONE CIVIC SQUARE BRADLEY FULKERSON CHECK AMOUNT: $45.00
CARMEL, INDIANA 46032 12245 LEIGHTON COURT
+.yi off co CARMEL IN 46032 CHECK NUMBER: 225814
CHECK DATE: 11/5/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 45 . 00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1164131
Carmel 0 Clay Payment Date: 10/18/13
Household #: 51658
Irs�f�c;�r���l�n
Monon Community Center Bradley Fulkerson Hm Ph: (317)663-0545
Carmel IN 46032 OCT 2 ®,� A 12245 Leighton Court
Carmel IN 46032 Cell Ph:(704)292-8659
Phone: (317)848-7275 $Y: emfulkerson @yahoo.com
Fed Tax ID#35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Activity Registration 45.00- 45.00 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 45.00
Processed on 10/18/13 @ 11:25:15 by BJJ NEW REFUND AMOUNT(-) 45.00
TOTAL REFUNDABLE AMOUNT 45.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 45.00 Made By==>REFUND FINAN With Reference=_> 1081-99-4358400 46✓
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issu
04_1`
61> Orized Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
Vt
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.
Fulkerson, Bradley Terms
12245 Leighton Court Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/18/13 1164131 Refund $ 45.00
I
Total $ 45.00
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.
Fulkerson, Bradley Allowed 20
12245 Leighton Court
Carmel, IN 46032
In Sum of$
$ 45.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members ,
Dept# INVOICE NO. ACCT#lTITL AMOUNT
1081-99 1164131 4358400 $ 45.00 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
FFUN
4-Nov 2013
Signature
$ 45.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund