HomeMy WebLinkAbout241056 1 /13/2015 J® �� CITY OF CARMEL, INDIANA VENDOR: 369025
ONE CIVIC SQUARE JEANETTE JEFFERIES CHECK AMOUNT: $*******159.56*
CARMEL, INDIANA 46032 10803 LAKEVIEW DRIVE CHECK NUMBER: 241056
9M�ruN ;r CARMEL IN 46033 CHECK DATE: 01/13/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 159.56 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1385252
Payment Date: 01/02/2015 a
Household#: 2828 �� ' + 0 .n
Home Phone: (317)846-5688 ,�
JAN 0 5 2015
BY-
JEANETTE JEFFERIS Monon Community Center
10803 LAKEVIEW DR Carmel IN 46032
CARMEL IN 46033
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details -- -- -- -
CANCELLATION -Refund Of 159.56
Pass Holder: Jeanette Jefferis Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: XMC Senr Annual (XM MCSA),#250447 - - -116.44 0.00 116.44 0.00 0.00
Valid Dates: 08/01/2014 to 08/01/2015 (Pass Cancellation)
Cancellation Effective: 01/02/2015
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
nAnnual MC Pass 116.44 1.00 0.00 0.00 116.44
Cancel Reason: Guest Request-Silver Sneakers
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 01/02/15 @ 08:00:16 by MNS FEES CHANGED ON CANCELLED ITEMS(.+) 159.56-
DISCOUNT APPLIED AGAINST CANCELLED FEES(-) 0.00
SALES TAX CHARGED ON CANCELLED FEES(+) 0.00
NET AMOUNT FROM CANCELLED ITEMS 159.56
TOTAL AMOUNT REFUNDED 159.56
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 159.56 Made By=_>REFUND FINAN With Reference=_>Silver Sneakers
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
A till . ���, � zis-7
Authorized Sig ature Date Authorized Signature Date
Escape Day Passes are non-refundable.
J o a''A m Cn
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.
Jefferis, Jeanette Terms
10803 Lakeview Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
112/15 1385252 Refund $ 159.56
Total $ 159.56
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
20_
Clerk-Treasurer
Voucher No. Warrant No.
Jefferis, Jeanette Allowed 20
10803 Lakeview Dr
Carmel, IN 46033
I Sum of$
I
$ 159.56
f
ON ACCOUNT OF APPROPRIATION FOR {`
109 -MCC
Po#or Board Members
Dept#
[HINVO:ICIENO�. ACCT#/TITL AMOUNT
1092 1385252 . 4358400 $ 159.56 I,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
i January 8, 2015
f
J' Signature
$ 159.56 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund