HomeMy WebLinkAbout256193 03/11/16 *�`�q+. CITY OF CARMEL, INDIANA VENDOR: 370376
ONE CIVIC SQUARE TERRY TERBUSH CHECK AMOUNT: $********33.26*
s. =a CARMEL, INDIANA 46032 16250 DURSLEY CT CHECK NUMBER: 256193
°M�roN.�.` WESTFIELD IN 46074 CHECK DATE: 03/11/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 1458788 33.26 REFUNDS AWARDS & INDE
Voucher No. Warrant No.
TerBush, Terry Allowed 20
16250 Dursley Ct
Westfield, IN 46074
In Sum of$
i
$ 33.26 ,
I
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1092 1458788 4358400 $ 33.26 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
i
March 7, 2016
Signature
$ 33.26 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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.
TerBush, Terry Terms
16250 Dursley Ct Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/3/16 1458788 Refund $ 33.26
Total $ 33.26
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
GLOBAL REFUND RECEIPT
Carmel 40
1458788
i 1 1 moment D '' f;r. ,03%03%16 "`�
Household#. 63936
f`ksa creat' h F,�
MAR 0 4 2010
Monon Community Center Terry,TerBUsh `� Hm Ph: (989)843-0209
Carmel IN 46032 16250Dursley Ct�
wUVewoce 'INS;46074 =
�, Cell Ph:(408)605-5763
64-67
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION -Refund Of 33.26
Pass Holder: Pam TerBush Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Senr Annual(M MCSA),#281140 386.74 0.00 386.74 0.00 0.00
---valid-Dates:---04/01/201-5-to-04/01/2016— (Pass-Cancellation)-- --
Cancellation
Pass-Cancellation)-- --Cancellation Effective: 03/03/2016
Cancel Reason: Guest Request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 03/03/16 @ 08:59:10 by MWHIRLEY FEES CHANGED ON CANCELLED ITEMS(+) 33.26-
NET AMOUNT FROM CANCELLED ITEMS 33.26-.
TOTAL AMOUNT.REFUNDED
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 33.26 Made B �
y=E�,,REFULIp FIN,�AN�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.
3 3 I b 91/1 AVAA L,2G'l2u uP?
Authorized Signature Date Authorized Signature Date - --
Escape Day Passes are non-refundable.
�D9a- y358`ioo
9
Page# 1 of 1