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Home My WebLink About258309 05/06/16 o CITY OF CARMEL, INDIANA VENDOR: 241763 ONE CIVIC SQUARE PETTY CASH CHECKAMOUNT: $*******231.14* CARMEL, INDIANA 46032 C/0 LISA CHECK NUMBER: 258309 C/0 LISA CHECK DATE: 05/06/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 050416 166.07 OTHER EXPENSES 651 5023990 050416 65.07 OTHER EXPENSES VOUCHER # 161386 WARRANT # ALLOWED 241763 IN SUM OF $ PETTY CASH -ADMIN C/O LISA Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 050416 01-6040-03 $37.00 050416 01-6040-05 $35.00 050416 01-6200-08 $6.74 050416 01-6360-07 $30.33 050416 01-6750-07 $33.00 050416 01-6750-08 $24.00 � j\Ix Voucher Total $166.07 Cost distribution ledger classification if claim paid under vehicle highway.fund Prescribed by State Board of Accounts City Form No.201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 241763 PETTY CASH -ADMIN Purchase Order No. C/O LISA Terms Due Date 5/3/2016 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/3/2016 050416 $166.07 hereby certify that the attached invoice(s), or bill(s) is (are) true and xrect and I have audited same in accordance with IC 5-11-10-1.6 Date Officer NUMBER DATE �1 �7�U PEkRIPTION r 30. 3_ f/ .CHARGE;TO"ACCOUNT . : .:.TOTAL .. A-9672/T-3008 L' lJ`�' � RECEIVED BY APPROVED BY -- ---------------------------------- CARMEL RETAIL STORE 275 MEDICAL DR CARMEL IN 460329998 1712760814 12/03/2015 (800)275-8777 10.44 AM Product Sale Final Description Qty Price First-Class 1 $0.49 Mail Letter (Domestic) (INDIANAPOLIS, IN 46205) (Weight:0 Lb 0.60 Oz) (Expected Delivery Day) (Saturday 12/05/2015) Certified 1 $3.45 (USPS Certified Mail #) (70142120000471582714) Return 1 $2.80 Receipt (USPS Return Receipt #) (9590952106150249246700) First-Class 1 $0.49 Mail Letter (Domestic) (NEWTON UPPER FALLS, MA 02464) (Weight:O Lb 0.30 Oz) (Expected Delivery'Day) (Monday 12/07/2015) Certified 1 $3.45 (USPS Certified Mail #) (70142120000471582707) Return 1 $,2.80 Receipt (USPS -Return Receipt #) (9590952106150249246458) First-Class 1 $0.49 Mail Letter (Domest 'c'). (SAINT AUGUST-INE, FL 32086) (Weight.'O Lb 0.30 Oz) (Expected Delivery Day) (Monday 12/07/2015).<'� Certified 1 , $3.45 (USPS Certified Mail #) (7014212000047158 2646) Return 1 $2.80 Receipt CUSPS Return Receipt #) (9590952106150249246694) First-Class 1 $0.49 Mail Letter (Domestic) (CARMEL, IN 46032) (Weight:O Lb 0.30 Oz) (Expected Delivery Day) (Saturday 12/05/2015) Certified 1 $3.45 (USPS Certified Mail #) (70141820000106341392) Return 1 $2.80 Receipt (USPS Return Receipt #) (9590952106150249246465) First-Class 1 $0.49 Mail Letter (Domestic) (CARMEL, IN 46033) (9590952106150249246694) First-Class 1 $0.49 Mail Letter (Domestic) (CARMEL, IN 46032) (Weight:0 Lb 0.30 Oz) (Expected Delivery Day) (Saturday 12/05/2015) Certified 1 $3.45 (USPS Certified Mail #) (70141820000106341392) Return 1 $2.80 Receipt (USPS Return Receipt #) (9590952106150249246465) First-Class 1 $0.49 Mail Letter (Domestic) (CARMEL, IN -46033) (Weight:0 Lb 0.30 Oz) (Expected Delivery Day) n (Saturday 12/05/2015) Certified 1 $3.45 (USPS Certified Mail #) (70142120000471582639) Return 1 $2.80 Receipt (USPS Return_Receipt #) (9590952106150249246472) First-Class 1 $0.49 Mai.] ' I i L-etter (Domestic) II (INDIANAPOLIS,'IN 46226) -(Weight:0 Lb 0.30-OZ) (Expected Delivery Day) (Saturday 12/05/2015) - Certified 1 $3.45 (USPS Certified:Mail #) (70142120000171582653) Return 1 $2.80 .:.; I Receipt (USPS Return Receipt V (9590952106150249246489) First-Class 1 �.' $0.49 Mail Letter ; (Domestic) (INDIANAPOLIS, IN 46250) - (Wei ght:O-Lb 9.5- Oz) , (Expected Delivery Day) (Saturday 12/,05_/2015) Certified 1 $3.45 (USPS Certified Mail #) j (70142120000471582660) Return 1 $2.80 Receipt (USPS Return Receipt #) (9590952106150249246496) First-Class 1 $0.49 Mail Letter (Domestic) (INDIANAPOLIS, IN 46241) (Weight:0 Lb 0.60 Oz) (Expected Delivery Day) (Saturday 12/05/2015) Certified 1 $3.45 (USPS Certified Mail #) (70142120000471582677) Return 1 $2.80 Receipt (USPS Return Receipt #) (9590952106150249246502) First-Class 1 $0.49 Mail Letter (Domestic) (CARMEL, IN 46032) (Weight:0 Lb 0.60 Oz) '-vu qui uuy to v.,i Luau, Certified 1 $3.45 (USPS Certified Mail #) (70142120000471582677) Return 1 $2.80 Receipt (USPS Return Receipt #) (9590952106150249246502) First-Class 1 $0.49 Mail Letter (Domestic) (CARMEL, IN 46032) (Weight:0 Lb 0.60 Oz) (Expected Delivery Day) (Saturday 12/05/2015) Certified 1 $3.45 (USPS Certified Mail #) (70142120000471582684) Return 1 $2.80 Receipt (USPS Return Receipt #) (9590952106150249246519) Total -- -- -- — $60.66 Cash - $61.00 Change ($0.34) For tracking or inquiries go to USPS.com or call 1-800-222-1811. In a hurry? Self-service kiosks offer quick and easy check-out. Any Retail Associate can show you how. YC 7t�yCyCiC7c)t�)C%C%CYtYc7C YC YCYCYfYcic'k YfX CYC Yc 7c 7c t YC yc*�Yc 7:YC Yc BRIGHTEN SOMEONE'S MAILBOX. Greeting cards available for purchase at select Post Offices. Order stamps at usps.com/shop or call 1-800-Stamp24. Go to iisps.com/clicknship to print shipping labels with postage. For other information call 1-800-ASK-USPS. xr�v��:e:r:evc�ce�vc�vc:rxr��se�c�c:e�rcrc��rcz�ee��ex Get your mail when and where you want it with a secure Post Office Box. Sign up for a box online at usps.com/poboxes.. YCYC 7C Y[��:C Y(7f�Y(7C Y(7(�YC:CYC7C%cY(7C 7C YC iC Y(7t'X YC YC Yc 7CX Yc 7r�7t All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER TELL US 18BOUT YOUR RECENT POST};.. EXPERIENCE Go to: https://postalexper-ience.com/Pos or scan this code with your mobile device: ti t ■ or call 1-800-410-7420. YOUR OPINION COUNTS p' ' Y, NUMBER . / DATE DESCRIPTIONU • CHARGEo.AccauU rorA� A-9672/T-3008 RECEIVED BY APPROVED BY BED BATH & BEYOND #564 1950-6 GREYHOUND PASS CARMEL, IN. 46033 317-574-0300 00564 10 02/19/16-1129 571049 51-9251 RVN # 0056-4925-1051-0219-1600 FILTER CHARC ALLCU 1N 8627911376 OUR PRICE 8.99 SUBTOTAL 8,99 TOTAL 8.99 CASH 10.00 CHANGE 1 .01 RUN # 0056-4925-1051-0219-1600 > Tax Exempt Transaction. . . . . . . «< >>> Id# 0031201550 «< THANKS FOR SHOPPING BED BATH & BEYOND { Visit us at www.bedbathandbeyond.com GIFT CARDS AVAILABLE ORIGINAL RECEIPT REQUIRED FOR REFUNDS 00564 10 02/19/16-1129 571049 51-9251 at, NUMBER DATE 3ob • • e • CHARGTOACCOUNT" - TOTAL A-9672/T-3008 RECEIVED BY APPROVED BY f DESCRIPTION OF ITEM/SERVICE PURCHASED AMOUNT fl ., 108tT hA,nnua.l Meting AN - SECTION AAWA Marriott Hotel-Indianapolis,IN 3auuary 23-28,2016 A L L A T T E N D E E S THINK SPRING MULCH, FERTILIZER, SEEDS & MORE! 554 SALE � 3/31/16 4:52PM TCS _____ �' (only one name per form) AWWA MEMBER#: b -------_- _ 820873-----_-----1---EA 4.49 EA ;D_ ORGANIZATION: L� l-McL 4.49 6PK AAA ALKALINE BATTERY EA 14.99 EA 700356 14.99 Ll 112 01 2PK POTATO GROW TUB cvZ$� FAX:{3i1 ��3 SUB-TOTAL: TOTAL 19.48 TAX: 1.36 : 1��P2tr+�c.. . 20.84 710 + (,,moi/ BC AMT: 20.84 �. The DEADLINE for ADVANCE BK CARD#: XXXXXXXXXXXX1683 lance:$125 ❑ On-site:$185 ID: 542929800846586 AMT: 20.84 ance:$215 o On-site:$265 r 8,2016 AUTH: 010017 ance:$i00 ❑ On-site:$135 Day: Host reference #:145399 Bat#0000 ance:$195 ❑ On-site:$230 Day: SWIPED EXPft: XXXX CARD TYPE:VISA ranges on pre-registration name badges.(Service Providers Only) mbers only) Trace # 089964 e: Bank card 20.84 %t Least 5 Years (UTILITY REGISTRANTS ONLY) Total Items: 2 III It 11 ii��ii��llil )n25$25 ==>> JRNL#B45399 <<== _ CUST # *5 Return this completed form with payment to the address below. THANK YOU LISA L KEMPA VA is enclosed. (Check no.: ) FOR YOUR PATRONAGE rCard' O American Express ❑Discover Signature: Exp.date: Security Code: Name : X I agree to pay above total amount according to card issuer agreement AL NEEDS RP.FJND P011CY RE117RNCOMPI,EM (merchant agreement if credit voucher) cable effort will be You can recover your pre-pay- FORM T0: Acct: CASH CUSTOMER immodate special ment by written request,post- Indiana,Section AWWA ease contact marked no later than Jan.4, 5265 E.82nd Street,#310 Customer COPY it(866)213-2796 2016,to Dawn Keyler. Indianapolis,IN 46250 er@lnawwa.org Request for refunds made after Office:(866)213.2796 with your request that date cannot be honored. FAX:(866)215-5966 �S�n Park car in any vacant space. Lock car and keep keys. Management of this facility will not be liable for personal property of any nature left in or on any car unless checked with cashier or for loss of or damage to any car due to fire, explosion, theft, collision or freezing .of radiator or battery or any other cause whatsoever unless due to negligence of parking employees acting in performance of their duties._ \N Managed By DENISON PARKING; INC.- 200 CENTURY-BUILDING 36 SOUTH PENNSYLVANIA.. PHONE:(317) 633-4003 Lane 4 352 951 PLACE°TICKET ON DASH = EXIT PASS_ GOOD FOR EVENTS ONLY RETAIN THIS TICKET. _ YOU-MAY-BE ASKED_ = FOR IT AT EXIT NO IN.&OUT.PRIVILEGES _LOT A &`-B. Toledo Ticket Co, Toledo,OH ..', � ... ic DATE ( /� DESCRIPTION • • CFIARGE TO'ACCOUN7 . 70TAL" A-9672/T-3008 _ RECEIVED BY -1 "A k-"4'221 ' APPROVED BY &44 Product Total 2016 Annual Conference-Utility Registration X 2 Attendee Name: �n+elJenkis Phone Number: (317)733-2855 Email: djenkinsaa,carmel.in.gov City,Town Or Company Name: City of Carmel Address: 3450 W. 131 st Street City:Carmel State: IN Zip: 46074 Pre Registration Price(Per Attendee): $125'00 One Day-Member($100,00) If One Day Indicate Tuesday Or Wednesday: Wednesday Wednesday Awards Lunch: Wednesday Awards Lunch, Qty: 1, Price: $25.00 2016 Annual Conference-Utility Registration X 1 AM0 Phone Number: (317)73.3-2855 Email:btolan ,carmel.in.gov City,Town Or Company Name: City of Carmel Address: 3450 W. 131 st Street City:Cannel State: IN Zip:46074 Pre Registration Price.(Per Attendee): $125.00 One Day-Member($100.00) If One Day Indicate Tuesday Or Wednesday: Wednesday Wednesday Awards Lunch: Wednesday Awards Lunch, Qty: 1, Price: $25.00 NY NUMBER DATE 6-O // DESCRIPTION'O�ITEWSEAVICE tPURC�A�,ED/ 7�� . 6:c�� .. 50,d CHARGE.TO;AC OUNT. TOTAL,' A•9672/T-3008 RECEIVED BY APPROVED BY 108th Annual Meeting INDIANA SECTION ANWA Marriott Hotel-ludiampolis,IN - 1 Jauuwy 25-2%2016 R E G I S T R A T 1 0 N FORM �Uulltyr A L L A T T E N D E E S ❑ Service Provider p j,, NAME: only a name per tam) AW2 WA MEMBER#: t 2 TITLE: C."To IL F ORGANIZATION: ADOREss: N90 w• 131 CITY I STATE 1 ZIP: eAAM J;IL f .�=Al• yb 6 7 / OFFICE TELEPHONE:(.31?) 733- 225S FAX: EMAIL: j 6PAMIZ-66 &A&&9L.I RG1M710N M The DEADLINEADVANCE registration Full conference-member* ❑ Advance:$125 ❑ On-site:$185 Jdn.812016 Full conference-non-member* ❑ Advance:$215 ❑ On-site:$265 One day-member*, Advance:$100 ❑ On-site:$135 Day: 1.46- aC f One day-non-member' ❑ Advance:$195 ❑ On-site:$230 Day: *A$10:00 fee W11 be charged for all on-site name changes on pre-registration name badges.(Service Providers Only) COMPL24MARYREGLS A170M ❑ Student,full-time ❑ Retired.(AWWA members only) ❑ Guest(Admittance to receptions only) Name: ❑ First time attendee t Haven't Attended in At Least 5 Years (UTILITY REGISTRANTS ONLY) EARLY BARD REGISTRATION Monday,Jan.25,3:00-7:00 p.m. MEAIS—Tkmts required ❑Tuesday,Jan.26,12-noon:Keynote luncheon-$25 ❑Wednesday,Jan.27,12-noon:Awards luncheon-$25 ❑Thursday,Jan.28,7:30 a.m.:Breakfast-$15 T f Enclosed:$ Return this completed form with payment to the address below. 14Check made payable to Indiana Section AWWA Is enclosed. (Check no.: ) o Please charge to my: o Visa o MasterCard o American Express o Discover Name as it appears on card: Signature: Billing address: Card number. Exp.date: Security Code- ONLY ONE NAME PER RECLAL N= REIM POLICY RE RM C)ONI 'iM Pm PLE40 Every reasonable effort will be You can recover your pre-pay- FORM 10. Photocopy the registration made to accommodate special ment by written request,post- Indiana Section AWWA form for use by others needs.Please contact marked no later than Jan.4, 5265 E.82nd Street 4310 or go to our web site Dawn Keyler at(866)213-2796 2016,to Dawn Keyler. Indianapolis,IN 46250 for additional fomes, or dawn.keyler@inawwa.org Request for refunds made alter Office:(866)213.2796 www.inawwa.org with your request. that date cannot be honored. FAX(866)216.5966 y c o NUMBrER 1 DATE O l• l� ( �OcO DESCRIPTION OF ITEWSERVICE PURCHASED a CHRA��TG i K 17ViFY[JF k A-9672/T-3008 RECEIVED BY APPROVED BY �� `� I _. _ ' '\ _ 3�� \ �� . { <��- cu co LL Jeiinruifer LU 0 co 0 z0 _~ .~~^~ ~/.~..�~. Trains ". """"'"``' . -_ Dusiness Date: 03/30/2016 Rec By: SAG C". C, DEL SEW LN 89:3O:22A / . < / Subtotal: 2.GO / 2O101el 0I S&ILK C'19-!MM Subtotal: $12.0O � 20,16D13810 DEL SEW LN O9:3O:22A ' SubtotaI: �12 UO / ^ | � co c2O16O13811 DEL SEW LN DIP:3U:22A Subtotal: $12.00 / / . 2016110-173 812 RELEASE O9:3 0 22'A | Subtotal: �= < 09:3O�22- | Subtotal: 1,2., / 2O16O13814 RELEASE OR 30 22A 'v Subtotal: $12 OO ` �� "� 2U16013815 RELEASE O9:3O:22A ' u' ' �� = ^ Su2 OO O R[E� C) o 2O16U13816 L O9:3O22A 2.UO ~ 2O16O13817 RELEASE O9:3O:22A M 85 � u� �- �� Subtotal: $12 8U � 25 � ^ < �� | �� 2O16O13818 RELEASE O9:3U:22A v 4J z C) C) ~~ V ry D~ tj _ U {] *» Subtotal: 12 Chu {J / 2O16O13819 RELEASE O9:JD:22A Subtotal: $12.00 ' 2016013820 RELEASE 09 2' � Subtotal: $12.0O | Prescribed by State Board of Accounts City Form No.201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 241763 PETTY CASH -ADMIN Purchase Order No. C/O LISA Terms Due Date 5/3/2016 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/3/2016 050416 $65.07 hereby certify that the attached invoice(s), or bill(s) is (are) true and ;orrect and I have audited same in accordance with IC 5-11-10-1.6 Date Officer f p NUMBER � 73601-'0 DATE DESCRIPTION OF • CHARGE T(?ACCQUHt TOTAL A-9672/T-3008t RECEIVED BY APPROVED BY- '`"i`',;lei THINK SPRING MULCH, FERTILIZER, SEEDS & MORE! 3/31/16 4:52PM TCS 554 SALE ---------------------------------------- 820873 1 EA 4.49 EA 6PK AAA ALKALINE BATTERY 4.49 700356 1 EA 14.99 EA 2PK POTATO GROW TUB 14.99 SUB-TOTAL: 19.48 TAX: 1.36 TOTAL- 20.84 BG AMT: 20.84 BK CARD#: XXXXXXXXXXXX1683 ID: 542929800846586 AUTH: 010017 AMT: 20.84 Host reference #:145399 Bat#0000 SWIPED CARD TYPE:VISA EXPR: XXXX Trace # 089964 Bank card 20.84 Total Items: 2 ==>> JRNL#845399 <<== CUST # *5 THANK YOU LISA L KEMPA FOR YOUR PATRONAGE Name X I agree to pay above total amount according to card issuer agreement (merchant agreement if credit voucher) Acct: CASH CUSTOMER Customer Copy NUMBER � G D � DATE r PTI o s -�s . . .. .......... ..... .. ... CHARGE,O ACCOUNT.; TOTAL A-9672/T-3008 RECEIVED BY APPROVED BY muuz6827 RELEASE 09:30,22A Subtotal: $12.0Q 2016013828 RELEASE 09:30;22� Subtotal: $12,88 2016013829 RELEASE 0030120''1 Subtotal5 $12.0 2016013830 RELEASE O9:JN224 Subtotal] M2.0O 2016O13831 RELEASE 0923022A ` Subtotal: $12.GO, 2MO13832 RELEASE O9:JO/224 Subtotal: $12.00 2916013813 RELEASE D9:%O22A / / Subtotal: $12.00 2016013034 RELEASE 09230:22o Sub�otal: $12.0O ' i 2016013835 RELEASE 09:302220 Wbtotai; $12.0O � 2216013836 RELEASE 89:30221 � subtotal/ $12,00 ' 2C16013837 RELEASE 59:10:221 Subtotal; =;12.0O 2016613838 RELEASE 09:3122� Subtotal: i12.00 . 2016013839 RELEASE 29:30:22A | Subtot al: $12.00 2016813840 RELEASE 8OMM | Subtotal: $12.80 [ ` 2016013841 RELEASE 09:38:22A | � / Subtotal: $1�.00 � $4OG.O0 Paid By Amuunt Re/ # � C0��kOF CARME�335.00 O8UU083�4 Cash 173.OO | ' Wl7Y 8F CARMEL �cv� Frum: CITY 8F CARH2L hue a GREAT day! ) \ — ' ' \ ' ^ Hamiltux Count Recnrder . O3/3U/2O16 O9:3O:23A Trans No 00006447 / . Business Date� U3/3O/2O16 Rec By: SAG 2016013808 DEL SEW LN 09:30:22A ` Subtotal:, $12.100 2016013809 DEL SEW LN 09:3122A Sub al12 ct : $ .DO | ` / 2016O1381O DEL SEW LK 09:30:22A Subtotal; $12.00, 2016013811 DEL SEW LN 0900,22A Subtotal: H2.00 2016013812 RELEASE 09230:22A ' Subtotal: $12.00 2016013813 RELEASE 09:30:22A ' Subtotal; 1112.80 2016013814 RELEASE 09:30:22A Subtotal: $12.00 2016013815 RELEASE 09:30:22A Subtotal: $12.00 2016013816 RELEASE 09:30:22A Subtotal: $12.00 2016013817 RELEASE 09:30:22A Subtotal: $12.011.) 2016013818 RELEASE 09:30/22A Subtotal:` 112.K" - 2016013819 RELEASE O9:3O/22A Subtntal: $12.10,0 2016013820 RELEASE 09:30:22A Subtotal: $12.DO 2016013821 RELEASE O9:3O:22A Subtntal: $12.00' 2016013822 RELEASE O9:3UMA Subtotal: $12.00 ` 2016013823 RELEASE 09:30:22A Subtotal: 12.UO 2016013824 RELEASE 09:30:22A Subtotal; $12.O8 2016013825 RELEASE 85:30:22A ' Subtutal: $12.00 2016013826 RELEASE COMM Subtotal: $12.00 2016013827 RELEASE O9:3O:22A Subtotal: $12.0O 2016013828 RELEASE GO3O:22A Subtotal: $12.0O 2016013829 RELEASE 09:30:22A Subtntal: $12.D0 2016013030 RELEASE 09:�:22A 65thal: $12.00 2016013831 RELEASE 09:3020%. Subtotal; $12.OO 2616012832 RELEASE 003O:224 Subtotal: $12.O1.1i 2016013813 RELEASE O9:322A �ubtotal: 2.010 | R DESCRIPTION OF ITEM/SERVICE PURCHASED AMOUNT r . � i I W,�W NUMBER DATE 0� 7„ 00, 08 DESCRIPTION OF ITEWSERVICE PURCHASED ..............................................................................._................................................__..._..._.._....._..__..._........._.__...._................._....................._.. .:._ .:........ GHAFiGE TO.ACCOUNT TOTAL;' A-9672/T-3008 RECEIVED BY APPROVED BY .cr, NUMB 70o 2.o DATE 3 /4 DESCRIPTION • ! • 00 CWARGE TO A COUN m; 70714E A-9672/T-3008 RECEIVED B APPROVED BY RV FILTER CNARC 8627911 M OUR SUBTOTAL TOTAL CASH 1 C� CHANGE 1.01 1111111 IIII IIII IIII II IIIIIIIIII II RUN $ 0056-9925-1051-0219-1600 »> Tax Exempt Transaction, . , . , . , << »> Id# 0031201550 '« THANKS FOR SHOPPING BED BATH & BEYON Visit us-'at www.bedbathandbeyorid,com GIFT CARDS AVAILABLE ORIGINAL RECEIPT REQUIRED FOR REFUND 00569 10 02/19/16--1129 571099 51-925 00 cx �cp