HomeMy WebLinkAbout238666 10/28/14 CITY OF CARMEL, INDIANA VENDOR: 360201
/ ��, ONE CIVIC SQUARE MARY JANE PERKINS CHECK AMOUNT: $********60.00*
:� % CARMEL, INDIANA 46032 1485 BEACONFIELD COURT CHECK NUMBER: 238666
9,,,�TON�. CARMEL IN 46033 CHECK DATE: 10/28/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 1359199 60.00 REFUNDS AWARDS & INDE
PASS REFUND RECEIPT
Receipt# 1359199
� yr
Payment Date: 10/22/14
Household#: 1209
I r & �m...Joh
Monon Community Center ' r� ° 'K T � Mary Jane Perkins Hm Ph: 317 574-1751
Carmel IN 46032 1485 Beaconfield Court Wk Ph: (317;574-1751
Carmel IN 46033 Cell Ph:(317)224-6411
OCT 2.3.2014
perkins.maryjane@yahoo.com
Phone: (317)848-7275 y
Fed Tax ID#35-6000972 '
Pass Details
CANCELLATION -Refund Of 60.00
Pass Holder: Mary Jane Perkins Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: UnGrpFit Annual(M UGFA),#82460 215.00 0.00 0.00 215.00 0.00
Valid Dates: - - 09/23/2009"to 09/23/2010 (Pass Cancellation)
Cancellation Effective: 10/22/2014
Cancel Reason: Per Michelle Yadon-Not allowed to bring in therapist
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10/22/14 @ 12:56:29 by SLEWALLEN FEES CHANGED ON CANCELLED ITEMS(+) 275.00-
SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 215.00-
NET AMOUNT:FROM:CANCEL-LED.'ITEMS-. 60:00-
TOTAL AMOUNT:REFWNDED= 60;0.0_'
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 60.00 Made By=_>REFUND FINAN With Reference=_>KLB
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks t process. No cash refunds will be
issued.
t0 ZL 1
Authorized Signature DateAuthorize/Sign Dat
Escape Day Passes are non-refundable.
1 0 2. 435$X100
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.
Perkins, Mary Jane Terms
1485 Beaconfield Court Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/22/14 1359199 Refund $ 60.00
Total $ 60.00
I hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with I C 5-11-10-1.6
, 20
Clerk-Treasurer
Voucher No. Warrant No.
Perkins, Mary Jane Allowed 20
1485 Beaconfield Court
Carmel, IN 46033
In Sum of$
$ 60.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
i
PO#or
Dept
INVOICE NO. ACCT#/TITLE AMOUNT I Board Members
Dept#
1092 1359199 4358400 $ 60.00 j 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
t
b
23-Oct 2014
i
j,
Signature
I
$ 60.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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