HomeMy WebLinkAbout239304 11/19/14 CITY OF CARMEL, INDIANA VENDOR: 368848
z' h`, ONE CIVIC SQUARE MATT LANE CHECK AMOUNT: $********34.50*
q, ,=q CARMEL, INDIANA 46032 12007 SOMERSET WAY EAST CHECK NUMBER: 239304
a'�rori"�°` CARMEL IN 46033 CHECK DATE: 11/19/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 1362629 34.50 REFUNDS AWARDS & INDE
PASS REFUND RECEIPT
Receipt# 1362629
Carmel 0C, ?Y Payment Date: 11/06/14
rksAecreativn Household#: 2356
Monon Community Center NOV 1 1 2014 Matt Lane Hm Ph: (317)663-4589
Carmel IN 46032 12007 Somerset Way East
Carmel IN 46033 Cell Ph:
-- lorenalane@mac.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION -Refund Of 34.50
Pass Holder: Lorena Lane Fees+Tax Discount Prev Paid Cur Paid . Amount Due
Pass Type: __ ___-,-,KZ-50-Visit(M Z50),#4948 40.50 0.00 40.50 ___0..00_ 0.0.0 _
Valid Dates: 05/31/2007 to 12/31/2099 (Pass Cancellation)
Cancellation Effective: 11/06/2014
Cancel Reason: prorated request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 11/06/14 @ 14:38:17 by LVA FEES CHANGED ON CANCELLED ITEMS(+) 34.50-
NET AMOUNT FROM CANCELLED ITEMS 34.50
TOTAL AMOUNT REFUNDED- 34.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 34.50 Made By==>REFUND FINAN With Reference==>prorated refund
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
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Authorized Si ature Dae Authorized Signature Date
Escape Day Passes are non-refundable.
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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.
Lane, Matt Terms
12007 Somerset Way East Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/6/14 1362629 Refund $ 34.50
Total $ 34.50
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
Clerk-Treasurer
i
I
i
Voucher No. Warrant No.
Lane, Matt: flowed 20
12007 Somerset Way East j
Carmel; IN 46033
Ih Sum of$
i
$ 34.50
ON ACCOUNT OF APPROPRIATION FOR
I
109 -MCC
,i
PO#or INVOICE No, ACCT#/TITLE AMOUNT Board Members
Dept#
I
1096-41 1362629 4358400 $ 34.50 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
i 14-Nov 2014
Signature
$ 34.50 Accounts Payable Coordinator
Cost distribution ledger classification if j Title
claim paid motor vehicle highway fund