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.
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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