HomeMy WebLinkAbout182319 02/17/2010 CITY OF CARMEL, INDIANA VENDOR: 363888 Page 1 of 1
ONE CIVIC SQUARE SHARON DERVINIS
CHECK AMOUNT: $55.00
9941 SUGERLEAF
CARMEL, INDIANA 46032
FISHERS IN 46038 CHECK NUMBER: 182319
ON
CHECK DATE: 2/17/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 384152 55.00 REFUNDS AWARDS INDE
FACILITY REFUND RECEIPT
Receipt 384152
Payment Date: 02/03/10
Household 30939
Monon Center Sharon Dervinis Hm Ph: (317)371 -6732
Car'mel IN 46032 9941 Sugarleaf
Fishers IN 46038 Cell Ph:
nsdervenis @aol.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Orig Bal Refund New Bal
Module: Facility Reservation 55.00- 55.00 0.00
GIL Co Descri Accoun Number Cst C ntr Description Account Num Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 55.00 DR
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 55.00
Processed on 02/03/10 16:43:48 by MML NEW REFUND AMOUNT 55.00
TOTAL REFUNDABLE AMOUNT 55.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 55.00 Made By REFUND FINAN With Reference gym refund
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued./,;qo ash r credit card refunds.
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Autha zed Signature Date Authorized Signature Date
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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.
Dervinis, Sharon Terms
9941 Sugarleaf Date Due
Fishers, IN 46038
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s))
55.00
Amount 213110 384152 Refund
Total 55.00
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.
Dervinis, Sharon Allowed 20
9941 Sugarleaf
Fishers, IN 46038
In Sum of
55.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept
1096 -50 384152 4358400 55.00 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
11 -Feb 2010
L&//Z l 2n
Signature
55.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund