HomeMy WebLinkAbout249413 09/09/15 ;c
CITY OF CARMEL, INDIANA VENDOR: 369813
ONE CIVIC SQUARE CHRISTOPHER ROBERGE CHECK AMOUNT: $**...**162.00'
f., CARMEL, INDIANA 46032 1998 TELFAIR ST CHECK NUMBER: 249413
CARMEL IN 46032 CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 162.00 PARKS DEPARTMENT REFU
A GLOBAL REFUND RECEIPT
Receipt# 1457543
arm-cl a clay _ Payment Date: 08/31/15
Barks&RE!creation
7SEP
Household #: 34406
0 1 2015
Monon Community Center Christopher Roberge Hm Ph: (317)815-9434
Carmel IN 46032 1998 Telfair St.
Carmel IN 46032 Cell Ph:(317)407-7009
Phone: (317)848-7275 croberge@robergelaw.com
Fed Tax ID#35-6000972
Pass Details
CANCELLATION - Refund Of 162.00
Pass Holder: Cara Roberge Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 20-Visit(ESE20V), #278988 108.00 0.00 108.00 0.00 0.00
Valid Dates: 08/13/2014 to 05/27/2015 (Pass Cancellation)
Cancellation Effective: 08/31/2015
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/31/15 @ 14:28:44 by JAB FEES CHANGED ON CANCELLED ITEMS(+) 162.00-
NET AMOUNT FROM CANCELLED ITEMS 162.00-
TOTAL AMOUNT REFUNDED 162.00
NEW NET HOUSEHOLD BALANCE 0.00
Re,und-of_= 62.00 Made By==>REFUND FINAN With Reference==>parent request;81-10-4358400 refund
All refunds are subject to StateBoard of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
�-..Authorised Signature Date t 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.
Roberge, Christopher Terms
1998 Telfair St Date Due
Carmel, IN 46032
Invoice ;1457543iE
Description
attached invoice(s) or bill(s)) Amount
Date 162.00
8/31/15 $
Total $ 162.00
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.
Roberge, Christopher Allowed 20
1998 Telfair St
Carmel, IN 46032
In Sum of$
$ 162.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-10 1457543 4358400 $ 162.00 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
September 4, 2015
Signature
$ 162.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund