183624 03/25/2010 a CITY OF CARMEL, INDIANA VENDOR: 363206 Page 1 of 1
ONE CIVIC SQUARE BLAIR CLARK CHECK AMOUNT: $115.73
CARMEL, INDIANA 46032 PO BOX 4104
4 CARMEL IN 46082 CHECK NUMBER: 183624
CHECK DATE: 3/2512010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 115.73 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 401813
Payment Date: 03/19/10
Household 21994
Monon Center Blair Clark Hm Ph: (317)201 -8640
Carmel IN 46032 Po Box 4104
Carmel IN 46082 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 115.73
Pass Holder. Blair Clark Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type. FIT Adlt Mnthly (M FTAM), #38824 12427 0.00 124.27 0.00 0.00
Valid Dates: 09/11/2009 to 09/11120 10 Pass Cancellation)
Cancel Reason: locker 96 delinquent; pass cancelled.
GIL Code Description Account Number Cst C ntr_ Description Account_ Number
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 115.73 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 03119/10 17:04:09 by TLP FEES CHANGED ON CANCELLED ITEMS 115.73
NET AMOUNT FROM CANCELLED ITEMS 115.73
TOTAL AMOUNT REFUNDED 115.73
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 115.73 Made By REFUND FINAN With Reference
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.
7&6uo
Authorized Signature U Date Authorized Signature Date
BY........
0
J 6""�
r
Page 1
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,
Clark, Blair Terms
P.O. Box 4104 Date Due
Carmel, IN 46082
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/19/10 401813 Refund 115.73
Total 115.73
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,
Clark, Blair Allowed 20
P.O. Box 4104
Carmel, IN 46082
In Sum of
115.73
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1092 401813 4358400 115.73 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
25 -Mar 2010
Signature
115.73 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I