181659 01/20/2010 CITY OF CARMFL, INDIANA VENDOR: 363803 Page 1 of 1
ONE CIVIC SQUARE JASON STROJINC CHECK AMOUNT: $27.00
k '0 CARMEL, INDIANA 46032 11720 BROCKFORD CT
os CARMEL.IN 46032 CHECK NUMBER: 181659
CHECK DATE: 1/20/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 372589 27.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 372589
Payment Date: 01/08/10
Household 13492
Monon Center Jason Strojinc Hm Ph: (317)538 -0723
Carmel IN 46032 11720 Brockford Ct.
Carmel IN 46032 Cell Ph: (440)503 -1973
Phone: (317)848 -7275
Fed`Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 27.00
Pass Holder: Lisa Strojinc Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: KZ 50 Visit (M Z50), #56845 48.00 0.00 48.00 0.00 0.00
Valid Dates: 02/04/2009 to 12/31/2099 Pass Cancellation)
Pass Visit Info: Number of Visits: 18
Cancel Reason: switched to full monon pass
G!L Code Description Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 27.00 DR
The REVENUE account was DEBITED and the CONTROL account was CREDITED on the day of the refund.
Finance will have to DEBIT the CONTROL account for the amounts listed above after the checks have been written to the customers.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 01/08/10 10:36:18 by LVA FEES CHANGED ON CANCELLED ITEMS 27.00
1 NET AMOUNT FROM CANCELLED ITEMS 27.00-
TOTAL AMOUNT REFUNDED 27:00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 27.00 Made By REFUND FINAN With Reference transfer to me pass
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued No cash or credit card refunds.
1
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Authorized •nature D to Authorize Signature D a e
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JAN 2 U O �r
Page 1
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized r a eustshow; knumbeervice,t where
ee per perr e dates service rendered, by
whom, rates per day, number of hours, per
Payee Purchase Order No.
Terms
Strajinc, Cason Date Due
11720 Brockford Ct.
Carmel, IN 46032
Invoice Invoice
Description Amount
Date Number (or note attached invoice(s) or bill(s)) 27.00
1/8/10 372589 Refund
Total 27.00
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.
Strojinc, Jason Allowed 20
11720 Brockford Ct.
Carmel, IN 46032
In Sum of$
27.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or Board Members
INVOICE NO. ACCT #!TITLE AMOUNT
Dept
1096 41 372589 4358400 27.00 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
14 -Jan 2010
Signature
27.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund