HomeMy WebLinkAbout234078 06/25/14 W,F�q
`% \ CITY OF CARMEL, INDIANA VENDOR: 368339
`` CHECK AMOUNT: $********70.00*
.!; 31• ONE CIVIC SQUARE HEATHER NIXON
_� CARMEL, INDIANA 46032 4426 CAMELOT LN CHECK NUMBER: 234078
MKroN�. CARMEL IN 46033 CHECK DATE: 06/25/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 70.00 REFUNDS AWARDS & INDE
PASS REFUND RECEIPT
Carmel Cly Receipt# 1271022
� � Payment Date: 06/12/14
Parks&Recreation Household#: 3133
JJ U I l' 20 14
Monon Community Center eather Nixon_ Hm Ph: (317)706-1164
Carmel IN 46032 s 426;Camelot Ln Wk Ph: (317)232-8253
Carmel IN 460.33 Cell Ph:(317)260-1344
armelnix@live.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION -Refund Of 70.00
Pass Holder: Joel Nixon Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 10-Visit(ESE10V),#231272 70.00 0.00 70.00 0.00 0.00 -
Valid Dates: 08/14/2013 to 05/29/2014 (Pass Cancellation)
Cancellation Effective: 06/12/2014
Cancel Reason: mongerneed ese
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/12/14 @ 15:05:00 by BJJ FEES CHANGED ON CANCELLED ITEMS(+) 70.00-
NET AMOUNT FROMCANCELLED ITEMS 70,00-
TOTAL AMOUNT REFUNDED. 7 70.00 .
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 70.00 Made By=_>REFUND FINAN With Reference=_>
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.,
_Authorized Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
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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.
Nixon, Heather Terms
4426 Camelot Ln Date Due
Carmel, IN 46033
invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/12/14 1271072 Refund $ 70.00
Total $ 70.00
I hereby certify that the attached invoice(s),or bili(s)is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
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i
Voucher No. Warrant No.
Nixon, Heather ;Allowed 20
4426 Camelot Ln
Carmel, IN 46033
1n Sum of$
$ 70.00
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ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
I,
PO#or Board Members
Dept# INVOICE NO. ACCT#/TlTLE AMOUNT
1081-5 1271072 4358400 $ 70.00 1 hereby certify that the attached invoice(s), or
,bili(s)is(are)true and correct and that the
materials or services itemized thereon for
(which charge is made were ordered and
!received except
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b
19-Jun 2014
j, Signature
$ 70.00 Accounts Payable Coordinator
I Cost distribution ledger classification if Title
claim paid motor vehicle highway fund !
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