245929 06/03/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 369410
CHECK AMOUNT: $********38.00*
ONE CIVIC SQUARE PAVAN NIZAMBADCARMEL, INDIANA 46032 14450 CAMDEN LANE CHECK NUMBER: 245929
CARMEL IN 46074 CHECK DATE: 06/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 38.00 REFUNDS AWARDS & INDE
k PASS REFUND RECEIPT
Receipt# 1449104 Carmel * ''?'
Payment Date: 05/26/2015
Household M 28440 farts& ecreapoh
Home Phone: (270)535-4996TT�� _
117)i_T_nom..:,
MAY 2 6 2015
PAVAN NIZAMBAD --- -__-_ _ Monon Community Center
14450 CAMDEN LN Carmel IN 46032
DIN 46074
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
MEMBERSHIP CHANGE -Refund Of 38.00
Pass Holder: Kavitha Krishnaswamy Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Adlt Mthly(M MCAM),#136373 102.00 0.00 102.00 0.00 0.00
Valid Dates: 05/03/2011 to 05/03/2012 (Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
nMonthly MC Pass 102.00 1.00 0.00 0.00 102.00
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 05/26/15 @ 12:16:07 by DMLEONARD FEES ADJUSTED ON CHANGED ITEMS(+) 38.00-
DISCOUNT APPLIED AGAINST THESE FEES(-) 0.00
SALES TAX CHARGED ON CHANGED FEES(+) 0.00
NET AMOUNT FROM CHANGED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 38.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 38.00 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.
9-12(c I 15r— 21IIAL"
Authorized Signature Date Authorized Signature Da e
Pcr? . 'f3 s,9.`-t Oo
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.
Nizambad, Pavan Terms
14450 Camden Ln Date Due
Carmel, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/26/15 1449104 Refund $ 38.00
b
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
, 20_
Clerk-Treasurer
Voucher No. Warrant No.
Nizambad, Pavan 'Allowed 20
14450 Camden Ln
Carmel, IN 46074
l'
In Sum of$
$ 38.00
I
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
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Dep #r INVOICE NO: ACCT#/TITL AMOUNT ll'
Board Members
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1092 1449104 4358400 $ 38.00 1 hereby certify that the attached invoice(s), or
bill(s)is(are)true and correct and that the
ti
materials or services itemized thereon for
which charge is made were ordered and
received except
i
May 28, 2015
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Signature
$ 38.00 ; Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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