242627 02/24/15 c'*.''u11 v.''u FI . CITY OF CARMEL, INDIANA VENDOR: 369139
A ONE CIVIC SQUARE ROBERT WOLFF CHECK AMOUNT: $ ...."38.00*
CARMEL, INDIANA 46032 264 BLUE RIDGE ROAD CHECK NUMBER: 242627
INDIANAPOLIS IN 46208 CHECK DATE: 02/24/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 38.00 REFUND
PASS REFUND RECEIPT
Receipt# 1410470
Car ISI '''a Payment Date: 02/17/15
JHousehold #: 42478
I r s Aecreatl o(I
Monon Community Center 2D15 I Robert Wolff Hm Ph: (317)848-5442
Carmel IN 46032 FEB 1 264 Blue Ridge Rd.
Indianapolis IN 46208 Cell Ph:(317)418-0763
robwolff13@gmail.com
Phone: (317)848-7275 -
Fed Tax ID#35-6000972
Pass Details
CANCELLATION - Refund Of 38.00
Pass Holder: Robert Wolff Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Adlt Mthly (M MCAM), #236453 350.00 0.00 0.00 350.00 0.00
Valid Dates: 03/05/2014 to 03/05/2015 (Pass Cancellation)
Cancellation Effective: 02/17/2015
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 02/17/15 @ 11:50:24 by SLEWALLEN FEES CHANGED ON CANCELLED ITEMS(+) 388.00-
SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 350.00-
NET AMOUNT FROM CANCELLED=.ITEMS 38:00-
3 TOTAL AMOUNT•REFUNDED . 38.00
Oq � � NEW NET HOUSEHOLD BALANCE
0.00
Refund of==> 38.00 Made By==>REFUND FINAN With Reference==>prime
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
/l. ,wok WWU VI --2-11 -7 / I
Authorized Signature Date Authorized Signature Date
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.
Wolff, Robert Terms
264 Blue Ridge Rd Date Due
Indianapolis, IN 46208
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/17/15 1410470 Refund $ 38.00
Total $ 38.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Wolff, Robert Allowed 20
264 Blue Ridge Rd
Indianapolis, IN 46208
In Sum of$
$ 38.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1092 1410470 4358400 $ 38.00 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
February 19, 2015
1PAN"Vn"
Signature
$ 38.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund