HomeMy WebLinkAbout238355 10/21/14 ,
"' CITY OF CARMEL, INDIANA VENDOR: 368797
{; ® ONE CIVIC SQUARE SHERRI DODD CHECK AMOUNT: $ ...."175.50"
r. C.Iq,?� CARMEL, INDIANA 46032 1544 MIRA LAGO CIR CHECK NUMBER: 238355
9.y�.,oN RUSKIN FL 33570 CHECK DATE: 10/21/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 175.50 REFUNDS AWARDS & INDE
flA
PASS REFUND RECEIPT
Carmel � Clay Receipt# 1353665
Payment Date: 10/10/14
I rks&Recr atian ri
FVJ ADoYz�� Household #: 11210
Monon Community Center 'bD
Si � �,/( Y) ��hPrri Dedd - Hm Ph: (317)818-8215
Carmel IN 46032 1��{ 1 11419-A rt Cts Wk Ph: (317)805-8215
Lkoo U Cell Ph:(317)442-5334
3dodds@global.net
Phone: (317)848-7275 115'�gnl -(-
Fed Tax ID#35-6000972 /
33s,�o
Pass Details
CANCELLATION - Refund Of 175.50
Pass Holder: Steffani Dodd Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 20-Visit(ESE20V), #215575 94.50 0.00 94.50 0.00 0.00
Valid Dates: 08/14/2013 to 05/31/2015 (Pass Cancellation)
Cancellation Effective: 10/10/2014
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10/10/14 @ 11:58:11 by BJJ FEES CHANGED ON CANCELLED ITEMS(+) 175.50-
NET AMOUNT FROM_CANCELLED ITEMS 175.50-
TOTAL AMOUNT REFUNDED 175.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 175.50 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
issue
ut ed Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
pi�eC���T�D
OCT 1 3 2014
tAo (0"JBY:
Page# 1 of 1
i
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.
Dodd, Sherri Terms
1544 Mira Lago Cir Date Due
Ruskin, FL 33570
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/10/14 1353665 Refund $ 175.50
I
Total $ 175.50
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.
Dodd, Sherri Allowed 20
1544 Mira Lago Cir
Ruskin, FL 33570
In Sum of$
$ 175.50
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-5 1353665 4358400 $ 175.50 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
which charge is made were ordered and
received except
16-Oct 2014
Signature
$ 175.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund