HomeMy WebLinkAbout233975 06/25/14 (9,
CITY OF CARMEL, INDIANA VENDOR: 368334
ONE CIVIC SQUARE LARRY BULINGTON CHECK AMOUNT: $********23.00*
CARMEL, INDIANA 46032 1712 BRIAM CIRCLE DR CHECK NUMBER: 233975
VALPARAISO IN 46383 CHECK DATE: 06/25/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 1278262 23.00 REFUNDS AWARDS & INDE
PASS REFUND RECEIPT
Receipt# 1278262
. � Payment Date: 06/16/14
Household#: 12692
Nrk" f 17C
Monon Community Center Larry Bulin n Hm Ph: (317)571-0061
65
Carmel IN 46032 125 a t. �+
Car 1 6032 addr eS3 Cell Ph:
Phone: (317)848-7275 (�
Fed Tax ID#35-6000972 I�
Pass Details
CANCELLATION -Refund Of 23.00
Pass Holder: - Larry BUlingtOn Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Senr Mthly(M MCSM),#126484 115.00 0.00 115.00 0.00 0.00
Valid Dates: 0.1/05/2014 to 01./04/2015 (Pass Cancellation)
Cancellation Eff6ctiVet 06/i 6/2014--
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VIA G l ul
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/16/14 @ 11:46:31 by DMLEONARD FEES CHANGED ON CANCELLED ITEMS(+) 23.00-
NET AMOUNT FROM.CANCELLED ITEMS 23.00-`
TOTAL:AMOUNT REFUNDED 23.00
ObgZ . 43S-F'400NEW NET HOUSEHOLD BALANCE 0.00
Refund of==> 23.00 Made By==>REFUND FINAN With Reference=_>Check
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
Authoriz natur date Authorized Signature ate
Escape Day Passes are non-refundable. r�
ew
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Page# 1 of 1
II
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.
Bulington, Larry Terms
1712 Briam Circle Dr Date Due
Valparaiso, IN 46383
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/16/14 1278262 Refund $ 23.00
Total $ 23.00
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
i
Voucher No. Warrant No.
Bulington, Larry A�lowed 20
1712 Briam Circle Dr
Valparaiso, IN 46383
In Sum of$
$ 23.00
ON ACCOUNT OF APPROPRIATION FOR
I
109 -MCC
1
I
I
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1092 1278262 4358400 $ 23.00 1 hereby certify that the attached invoice(s), or
bfll(s)is(are)true and correct and that the
materials or services itemized thereon for
v'hich charge is made were ordered and
received except
r
19-Jun 2014
l
I
Signature
$ 23.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund