HomeMy WebLinkAbout246210 06/17/15 0R `/ z� CITY OF CARMEL, INDIANA VENDOR: 369479
= ONE CIVIC SQUARE RICHARD BERNHARDT CHECK AMOUNT: $********38.00*
,_� CARMEL, INDIANA 46032 11394 ST.ANDREWS LANE CHECK NUMBER: 246210
''y;_�_/ CARMEL IN 46032 CHECK DATE: 06/17/15
«ON�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 1451136 38.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1451136
Payment Date: 06/09/2015
Household#: 47683 » ° q - - 1'CS& ' Cr caEon .
Home Phone: (317)218-3639
Work Phone: 413-8452
317
( ) JUN 1 2 2015
BY
RICHARD BERNHARDT Monon Community Center
11394 ST.ANDREW'S LANE Carmel IN 46032
CARMEL IN 46032
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION -Refund.Of 38.00
Pass Holder: Carrie Bernhardt Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Adlt Mthly(M MCAM),#273071 114.00 0.00 114.00 0.00 0.00
Valid Dates: 01/31/2015 to 01/31/2016 (Pass Cancellation)
Cancellation Effective: 06/09/2015
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
nMonthly MC Pass 114.00 1.00 0.00 0.00 114.00
Cancel Reason: double billed
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/09/15 @ 11:12:37 by KHOBLIK FEES CHANGED ON CANCELLED ITEMS(+) 38.00-
DISCOUNT APPLIED AGAINST CANCELLED FEES(-) 0.00
SALES TAX CHARGED ON CANCELLED FEES(+) 0.00
NET AMOUNT FROM CANCELLED ITEMS 38.00-
TOTAL 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
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Authorized Signature Date Authorized Signature Date
L07�,, 4� 57/qo
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.
Bernhardt, Richard Terms
11394 ST Andrews Lane Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/9/15 145.1136 Refund $ 38.00.
Total $ 38.00
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.
Bernhardt, Richard (Allowed 20
11394 ST Andrews Lane
Carmel, IN 46032 I„
in Sum of$
$ 38.00
ON ACCOUNT OF APPROPRIATION FOR
1.09 -MCC
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1092 1451136 4358400 $ 38.00 l hereby certify that the attached invoice(s), or
pill(s)is (are)true and correct and that the
materials or services itemized thereon for
Which charge is made were ordered and
I except
I �
i
June 12, 2015
Signature
$ 38.00 j Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I