245888 06/03/15 y��,C.Iggl
/ ��� CITY OF CARMEL, INDIANA VENDOR: 369417
'� ONE CIVIC SQUARE JACOB JUMEY CHECK AMOUNT: $********76.00*
CARMEL, INDIANA 46032 800 BENNETT ROAD CHECK NUMBER: 245888
9�'IroN"ED� CARMEL IN 46032 CHECK DATE: 06/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 76.00 REFUNDS AWARDS & INDE
PASS REFUND RECEIPT
Receipt# 1448490
Payment Date: 05/21/15
f Household#: 18903
lonon Community Center MAY 2 2 2015 Jacob Jurney Hm Ph: (317)848-0519
armel IN 46032 800 Bennett Road
�•y Carmel IN 46032 Cell Ph:
hone: (317)848-7275 ,
ed Tax ID#35-6000972
'ass Details
CANCELLATION
Pass Holder: John Jurney Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Adlt Mthly (M MCAM),#191084 152.00 0.00 0.00 152.00 0.00
Valid Dates: 12/20/2014 to 12/19/2015 (Pass Cancellation)
Cancellation Effective: 05/21/2015
CANCELLATION -Refund Of 76.00
Pass Holder: Lynn Jurney Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Adlt Mthly(M MCAM),#191085 152.00 0.00 0.00 152.00 0.00
Valid Dates: 12/20/2014 to 12/19/2015 (Pass Cancellation)
Cancellation Effective: 05/21/2015
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 05/21/15 @ 17:14:23 by KLB FEES CHANGED ON CANCELLED ITEMS(+) 380.00
SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 304.00
NET AMOUNT FROM CANCELLED ITEMS,'. 76.00
TOTAL AMOUNT-;REFUNDED 76:00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 76.00 Made By=_>REFUND FINAN With Reference
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
- 521 IS
Authorized Signature Date Authorized nature Date
Escape Day Passes are non-refundable.
1 oq�.y35�{o0
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.
Jurney, Jacob Terms
800 Bennett Road Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5121/15 1448490 Refund $ 76.00
Total $ 76.00
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. .
Jurney,-Jacob Allowed 20
800 Bennett Road
Carmel, IN 46032
In Sum of$ ,
$, .. . 76..00
ON ACCOUNT OF APPROPRIATION FOR
109 =MCC
PO#or Board Members
INVOICE NO. ACCT#/TITL AMOUNT
Dept# '.
1092 1448490 .4358400 $ 76.00 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
1 which charge is made were ordered and
i' received except
May 29,2015
1
1. F
I` Signature
$, 76.00 Accounts.Payable Coordinator-
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund