HomeMy WebLinkAbout236170 08/19/14 ♦i,W�4q'�sp
CITY OF CARMEL, INDIANA VENDOR: 365049
ONE CIVIC SQUARE CHARLOTTE LIPPERT CHECK AMOUNT: $*M w 1111 M►108.00`
;. � CARMEL, INDIANA 46032 12785 FORSYTH ST CHECK NUMBER: 236170
CARMEL IN 46032 CHECK DATE: 08/19/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 1329741 108.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Py Receipt# 1329741
Mel Payment Date: 08/14/14
_ Household#: 16816
AUG G 1 4 2014
Monon Community Center Charlotte Lippert Hm Ph: (317)519-7421
Carmel IN 46032 Y: 12785 Forsyth St
--- Carmel IN 46032 Cell Ph:
douglas.lippert@gmail.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Refund Details
Oria Bal Refund New Bal
Module: Pass Management 108.00- 108.00 0.00
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 108.00
Processed on 08/14/14 @ 11:40:49 by BJJ NEW REFUND AMOUNT(-) 108.00
TOTAL REFUNDABLE AMOUNT 108.00'
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 108.00 Made By=_>REFUND FINAN With Reference=_>1081-10-435840 �j�
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
rzed Signature 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.
Lippert, Charlotte Terms
12785 Forsyth St Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/14/14 1329741 Refund $ 108.00
Total $ 108.00
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
, 20
Clerk-Treasurer
Voucher No. Warrant No.
Lippert, Charlotte Allowed 20
12785 Forsyth St
Carmel, IN 46032
' In Sum of$
$ 108.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
I
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1081-10 1329741 4358400 $ 108.00 1 hereby certify that the attached invoice(s), or
bill(s)is(are)true and correct and that the
i materials or services itemized thereon for
which charge is made were ordered and
received except
j
14-Aug 2014
Signature
$ 108.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund