HomeMy WebLinkAbout233474 06/11/14 C.IN
' CITY OF CARMEL, INDIANA VENDOR: 368272
® r ONE CIVIC SQUARE JONATHAN ERIKSEN CHECK AMOUNT: $""'*'285.00'
CARMEL, INDIANA 46032 8124 N LINCOLN BLVD CHECK NUMBER: 233474
'+;,��ON ._ INDIANAPOLIS IN 46240 CHECK DATE: 06/11/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 1259579 285.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1259579 Carrel 9 Clod
Payment Date: 05/30/2014
Household #: 19339 _Parks&Recreation
Home Phone: (317)259-4450
Work Phone: (317)843-3555A�r��
JUN 2 2014
JONATHAN ERIKSEN Monon Community Center 1j}(.
8124 N LINCOLN BLVD Carmel IN 46032
INDIANAPOLIS IN 46240
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION - Refund Of 285.00
Pass Holder: Stephanie Eriksen Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Seas WPk HH (SAQHR), #245450 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/24/2014 to 09/02/2014 (Pass Cancellation)
Cancellation Effective: 05/30/2014
Cancel Reason: Pass Cancellation - Not happy with clientelle facility
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 05/30/14 @ 09:04:18 by MNS FEES CHANGED ON CANCELLED ITEMS(+) 285.00-
DISCOUNT APPLIED AGAINST CANCELLED FEES(-) 0.00
SALES TAX CHARGED ON CANCELLED FEES(+) 0.00
NET AMOUNT FROM CANCELLED ITEMS 285.00-
TOTAL AMOUNT REFUNDED 285.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 285.00 Made By==>REFUND FINAN With Reference==>Not Happy with Facil
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
'513, oltq
Authorized gna ure 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.
Eriksen, Jonathan Terms
8124 N Lincoln Blvd Date Due
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/30/14 1259579 Refund $ 285.00
Total $ 285.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Eriksen, Jonathan Allowed 20
ylp� 8124 N Lincoln Blvd
Indianapolis, IN 46240
In Sum of$
$ 285.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITL AMOUNT
1092 1259579 4358400 $ 285.00 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
6-Jun 2014
Signature
$ 285.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund