HomeMy WebLinkAbout183168 03/16/2010 CITY OF CARMEL, INDIANA VENDOR: 363963 Page 1 of 1
ONE CIVIC SQUARE JAIMIE MILLER
CARMEL, INDIANA 46032 13889 FIELDSHIRE TR CHECK AMOUNT: $28.00
WESTFIELD IN 46074
CHECK NUMBER: 183168
CHECK DATE: 3/16/2010
.r
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 396921 28.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 396921
Payment Date: 03/10/10
Household 31870
Monon Center Jaime Miller Hm Ph: (317)873 -3001
i'
Carmel IN 46032 �3$` CL 5v tk e. f Wk Ph: (317)569 -0086
V112;7 l L4tp01(� Cell Ph: (317)341 -0323
jmi11498 att.nel
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 28.00
Pass Holder: Jaime Miller Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: KZ 10 Visit (M Z10), #88542 12.00 0.00 12.00 0.00 0.00
Valid Dates: 11/27/2009 to 12/31/2099 Pass Cancellation)
Pass Visa Into: Number of Visits: 7
Cancel Reason: prorated request
G/L Code_ Descriptio __n___ Account Number Cntr Description Account Number
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 28.00 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 03/10/10 15:18.55 by LVA FEES CHANGED ON CANCELLED ITEMS 28.00
NET AMOUNT FROM CANCELLED ITEMS 28.00
TOTAL AMOUNT REFUNDED 28.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 28.00 Made By REFUND FINAN With Reference prorated request
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issu No cash or credit card refunds.
Ito
Authorized Si at Date Authorized ignature Date
C� q
A MAR 1 1 2010 o d
Pro ram 12eq
Page 1
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill tube 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.
Miller, Jaime Terms
13889 Fieldshire Tr Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/10/10 396921 Refund 28.00
Total 28.00
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
Voucher No. Warrant No.
Miller, Jaime Allowed 20
13889 Fieldshire Tr
r
Westfield, IN 46074
In Sum of
28.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -41 396921 4358400 28.00 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 -Mar 2010
Signature
28.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund