HomeMy WebLinkAbout326578 06/28/2018 `%'��p\'' CITY OF CARMEL, INDIANA VENDOR: T362687
'i. CHECK AMOUNT: $*******243.94*
.�: ONE CIVIC SQUARE GREGORY GORSKI
:9 �� CARMEL, INDIANA 46032 1746 ALTAVISTA CIRCLE CHECK NUMBER: 326578
.y��ioN�°, LAKELAND FL 33810 CHECK DATE: 06/28/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 2000826004 243.94 REFUNDS AWARDS & INDE
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
VOUCHER NO. WARRANT NO.
An invoice of bill to be properly itemized must show;kind of service,where performed,dates service rendered,by
Vendor Allowed 20_ whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
Gorski, Gregory Payee
,(ftp 1746 Altavista Circle
`\ Lakeland, FL 33810 In Sum of$ Purchase Order#
Gorski, Gregory Terms
$ 243.94 1746 Altavista Circle Date Due
Lakeland, FL 33810
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO#or Invoice nvolce Description
Dept# INVOICE NO. ACCT#/TITLE AMOUNT Date Number (or note attached invoice(s)or bill(s)) PO# Amount
1092 2000826004 4358400 $ 243.94 Board Members 6/13/18 2000826004 Refund $ 243.94
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
$ 243.94 Total $ 243.94
June 21,2018
I hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
Y
with IC 5-11-10-1.6
Cost distribution ledger classification if
claim paid motor vehicle highway fund Signature 20_
Accounts Payable Coordinator Clerk-Treasurer
Title
Receipt#2000826.004 Page 1 of 1
a *:
Monon Community Center West VDu ,Ker " # 0000$_26.004
Building J'un 13, 218 .4'0'PM- y
1195 Central Park Dr. West
Carmel, IN 46032
Phone: (317) 848-7275 � ► 4oft Clay .
FAX: arlarwi lel .*
Email..
info@carmelclayparks.com
Nrks&Recreali
Nab Irl GOLD MEDAL WINNER
ME
ORY GORSK�I�
new adts ACCREDITED AGENCY
�e UVjPrepared By: hollypg
. .Loot
aAA Customer ID: 11175
Primary phone: (317) 848-2511, Secondary phone: (317) 848-2511
Refund Summary
heck: ($243:9}4)Cfieck
Total Received: ($243.94)
0 ,51-M fu-nd:- - - -
Transactions
Customer Description Item Unit Qty Fee Charge
Gregory Gorski Senior Annual (Legacy) Pass Membership Each 1.00 $243.94 ($243.94)
13164 Derbyshire'Court Action:Membership Cancel Fee
Carmel,iN 46032 Expires: Mar 31,2018
Primary phone:(317)848- Pass# 130001967: Gregory Gorski
2511 Thanks for your purchase!
Email:mom5752@att.net
ID: 11175
Total Charges ($243.94)
Total Payments ($243.94)
Balance $0
Fy-
c)q
'77�'i F, K-5
-
Federal Tax ID # 35-6000972
1 8 2018
2. . 6) C�
https://anprod.active.com/carmelclayparks/servlet/processReceiptPayment.sdi 6/13/2018