HomeMy WebLinkAbout241143 01/13/15 r Coq -
�.°... .,,f CITY OF CARMEL, INDIANA VENDOR: 369026
® ONE CIVIC SQUARE ROBERT SPALLER CHECK AMOUNT: $**-...55.95`
CARMEL, INDIANA 46032 2944 TOWNE DR CHECK NUMBER: 241 143
CARMEL IN 46032 CHECK DATE: 01/13/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 55.95 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1387030 � .� lad.
Payment Date: 01/06/2015
Household #: 4722 Park�'&R r6, fi'-
Home Phone: (317)872-0640
Work Phone: (317)872-0640 �> T�r�:I�
JAN 0 $. 2015
ROBERT SPALLER BY:
Monon Community Center
2944 TOWNE DRIVE Carmel IN 46032
CARMEL IN 46032
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION - Refund Of 55.95
Pass Holder: Patricia Spaller Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: XMC Senr Annual (XM MCSA), #238053 220.05 0.00 220.05 0.00 0.00
Valid Dates: 03/21/2014-to-03/21/2015—(Pass-Cancellation) -=- — ------ -- ------------
Cancellation Effective: 01/06/2015
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
nAnnual MC Pass 220.05 1.00 0.00 0.00 220.05
Cancel Reason: guest request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 01/06/15 @ 12:14:33 by HPG FEES CHANGED ON CANCELLED ITEMS(+) 55.95-
DISCOUNT APPLIED AGAINST CANCELLED FEES(-) 0.00
SALES TAX CHARGED ON CANCELLED FEES(+) 0.00
-NET°AMOUNT FROM=GANCELLED=ITEMS= ==—55:95 ? .
/ TOTAL AMOUNT REFUNDED 55.95
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 55.95 Made By=_>REFUND FINAN With Reference=_>check
All refunds are subject to State Board of Acc,,u is procedures and may take 4-6 weeks to process. No cash refunds will be
issued. _
I
Authorized ign ure Date Authorized Signature ate
Escape Day Passes are non-refundable.
.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.
Spaller, Robert Terms
2944 Towne Drive Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/6/15 1387030 Refund $ 55.95
Total $ 55.95
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Spaller, Robert Allowed 20
2944 Towne Drive
Carmel, IN 46032
In Sum of$
$ 55.95
ON ACCOUNT OF APPROPRIATION FOR
109 - MCC
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITLE AMOUNT
1092 1387030 4358400- $ 55.95 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
January 8, 2015
Signature
Is 55.95 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund