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HomeMy WebLinkAbout236396 08/27/14 J`® �F• CITY OF CARMEL, INDIANA VENDOR: 368602 t ONE CIVIC SQUARE LYNDELL HAENLEIN CHECK AMOUNT: $********75.00* s9 =a; CARMEL, INDIANA 46032 7637 CLIFTON BRIDGE LANE CHECK NUMBER: 236396 ''�lrori�°' CAMBY IN 46113 CHECK DATE: 08/27/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1092 4358400 1335008 75.00 REFUNDS AWARDS & INDE z PASS REFUND RECEIPT Receipt# 1335008 � arM e: + Payment Date: 08/20/14 Household#: 56481 Monon Community CenterLyndell Haenlein Hm Ph: (317)847-2998 Carmel IN 46032 7637 Clifton Bridge Lane AUG 2 2014 Camby IN 46113 Cell Ph: I Imbrown136@aol.com Phone: (317)848-7275 Fed,Tax ID#35-6000972 Pass Details MEMBERSHIP CHANGE-Refund Of 75.00 Pass Holder: Lyndell Haenlein Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: UnGrpFit Annual (M UGFA),#223572 225.00 0.00 225.00 0.00 0.00 Valid Dates: 11/04/2013 to 11/04/2014 (Pass Cancellation) PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed �on�0Q8�/20/14 @ 14:16:31 by NMH FEES ADJUSTED ON CHANGED ITEMS(+) 75.00- 'NET AMOUNT FROM,CHANGED,;ITEMS- sk �� L� TOTAL AMOUNT REFUNDED 75.00, Se4 QJVY� 11 ,, ^^ NEW NET HOUSEHOLD BALANCE 0.00 Refund of=_> 75.00 Made By=_>REFUND FINAN With Reference=_>Staff Error All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be issued. « � <:��6L Authorized Signature Date Authorized Signature Date Escape Day Passes are non-refundable. I 01 ��� 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. Haenlein, Lyndell Terms 7637 Clifton,Bridge Lane Date Due Camby, IN 46113 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 8/20/14 1335008 Refund $ 75.00 Total $ 75.00 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 Voucher No. Warrant No. Haenlein, Lyndell Allowed 20 7637 Clifton Bridge Lane Camby, IN 46113 Iii Sum of$ r $ 75.00 ON ACCOUNT OF APPROPRIATION FOR 109 -MCC PO#orBoard Members Dept# INVOICE NO. ACCT#/TITLE AMOUNT I 1092 1335008 4358400 $ 75.00 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 iwhich charge is made were ordered and received except I I 22-Aug 2014 Signature $ 75.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund