251168 11/04/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 361046RM4*yONE CIVIC SQUARE LISA BERRY CHECK AMOUNT: S 315.00'CARMEL, INDIANA 46032 4964 JENNINGS DRIVE CHECK NUMBER: 251168
CARMEL IN 46033 CHECK DATE: 11/04/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 315.00 REFUNDS AWARDS & INDE
PASS REFUND RECEIPT
Receipt# 1458429
Carmel 0 Clay Payment Date: 10/28/15
Palrks&Recreatlo Household #: 6827
�.CEIVED
Monon Community Center OCT 2 9 2015 Lisa Berry Hm Ph: (317)663-3211
Carmel IN 46032 4964 Jennings Drive Wk Ph: (317)573-4024
1By: Carmel IN 46033 Cell Ph:(317)518-7287
lisa.berry@indy.rr.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION - Refund Of 45.00
Pass Holder: Abby Berry Fees+Tax Discount Prey Paid Cur Paid Amount Due
Pass Type: 10-Visit(ESE10V), #258776 0.00 0.00 0.00 0.00 0.00
Valid Dates: 08/13/2014 to 05/27/2015 (Pass Cancellation)
Cancellation Effective: 10/28/2015
CANCELLATION - Refund Of 45.00
Pass Holder: Abby Berry Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 10-Visit(ESE10V), #258777 0.00 0.00 0.00 0.00 0.00
Valid Dates: 08/13/2014 to 05/27/2015 (Pass Cancellation)
Cancellation Effective: 10/28/2015
CANCELLATION - Refund Of 45.00
Pass Holder: Abby Berry Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 10-Visit(ESE10V), #258778 0.00 0.00 0.00 0.00 0.00
Valid Dates: 08/13/2014 to 05/27/2015 (Pass Cancellation)
Cancellation Effective: 10/28/2015
CANCELLATION -Refund Of 45.00
Pass Holder: Abby Berry Fees+Tax Discount Prey Paid Cur Paid Amount Due
Pass Type: 10-Visit(ESE10V), #260509 0.00 0.00 0.00 0.00 0.00
Valid Dates: 08/13/2014 to 05/27/2015 (Pass Cancellation)
Cancellation Effective: 10/28/2015
CANCELLATION -Refund Of 45.00
Pass Holder: Abby Berry Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 10-Visit(ESE10V), #260510 0.00 0.00 0.00 0.00 0.00
Valid Dates: 08/13/2014 to 05/27/2015 (Pass Cancellation)
Cancellation Effective: 10/28/2015
Page# 1 of 2
PASS REFUND RECEIPT -
CarmelI lY Receipt# 1458429
rks& ecreatid 9 Payment Date: 10/28/2015
Household #: 6827
CANCELLATION -Refund Of 45.00
Pass Holder: Abby Berry Fees+Tax Discount 'Prev Paid Cur Paid Amount Due
Pass Type: 10-Visit(ESE10V), #260511 0.00 0.00 0.00 0.00 0.00
Valid Dates: 08/13/2014 to 05/27/2015 (Pass Cancellation)
Cancellation Effective: 10/28/2015
CANCELLATION - Refund Of 45.00
Pass Holder: Abby Berry Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 10-Visit(ESE10V), #260512 0.00 0.00 0.00 0.00 0.00
Valid Dates: 08/13/2014 to 05/27/2015 (Pass Cancellation)
Cancellation Effective: 10/28/2015
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10/28/15 @ 12:57:03 by BJJ FEES CHANGED ON CANCELLED ITEMS(+) 315.00-
NET AMOUNT FROM CANCELLED ITEMS 315.00-
TOTAL AMOUNT REFUNDED 315.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 315.00 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
&AK0511-led Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
I
oil �
Page# 2 of 2
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.
Berry, Lisa Terms
4964Jennings Drive Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/28/15 1458429 Refund $ 315.00
Total $ 315.00
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
6 Voucher No.
Warrant No.
Berry, Lisa
4964Jennings Drive Allowed
Carmel, IN 46033 20
In Sum of$
$ 315,00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or
Dept# INVOICE NO. ACCT#/TITL
AMOUNT Board Members
1081-5 1458429 4358400
$ 315.00 I 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
October 30, 2015
$ 315.00 Signature
Cost distribution ledger classification if Accounts Payable Coordinator
claim paid motor vehicle highway fund Title