247554 07/15/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 369563
ONE CIVIC SQUARE KAREN ZURECHER CHECK AMOUNT: $*******121.50*CARMEL, INDIANA 46032 14502 COTSWOLD LANE CHECK NUMBER: 247554
CARMEL IN CHECK DATE: 07/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 121.50 REFUNDS AWARDS & INDE
` PASS REFUND RECEIPT
Receipt# 1454262
r r. t- l lay Payment Date: 07/02/15
DarksAecreation Household #: 6826
4.6. 2015 {
Monon Community Center Karen Zurcher Hm Ph: (317)569-1704
Carmel IN 46032
JULT14502 Cotswold Lane Wk Ph: (317)523-3611
BAY'- Carmel IN 46033 Cell Ph:(317)201-5202
--�'
Phone: (317)848-7275 kzurks@gmail.com
Fed Tax ID#35-6000972
Pass Details
CANCELLATION - Refund Of 121.50
Pass Holder: Paige Zurcher Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 20-Visit(ESE20V), #217115 148.50 0.00 148.50 0.00 0.00
/ Valid Dates: 08/14/2013 to 05/29/2016 (Pass Cancellation)
Cancellation Effective: 07/02/2015
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/02/15 @ 15:19:30 by BJJ FEES CHANGED ON CANCELLED ITEMS(+) 121.50-
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 121.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 121.50 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, I
uthori ignature Date Authorized Signature Date
Escape Day Passes are non-refundable.
6 �
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r�" l
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.
Zurecher, Karen Terms
14502 Cotswold Lane Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/2/15 1454262 Refund $ 121.50
Total $ 121.50
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.
Zurecher, Karen Allowed 20
14502 Cotswold Lane
Carmel, IN 46033
In Sum of$
$ 121.50
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept#
1081-2 1454262 4358400 $ 121.50 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
July 9, 2015
Signature
$ 121.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund