HomeMy WebLinkAbout183611 03/25/2010 CITY OF CARMEL, INDIANA VENDOR: 363992 Page 1 of 1
ONE CIVIC SQUARE SHEHZADI ANSARI
CARMEL, INDIANA 46032 12517 PEMBROOKE CIRCLE CHECK AMOUNT: $25.50
CARMEL IN 46032
<ro„ CHECK NUMBER: 183611
CHECK DATE: 3/25/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 25.50 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 401144
Payment Date: 03/16/10
Household 951
Monon Center Shehzadi Ansari Hm Ph: (317)810 -9311
Carmel IN 46032 12517 Pembrooke Circle Wk Ph: (317)514 -6727
Carmel IN 46032 Cell Ph:
she hzy_ansari yahoo,com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 25.50
Pass Holder: Shehzadi Ansari Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: KZ 50 Visit (M Z50), #45386 49.50 0.00 49.50 0.00 0.00
Valid Dates: 09/03/2009 to 12/31/2099 Pass Cancellation)
Pass Visit Info: Number of Visits: 17
Cancel Reason: prorated request
G/ Code Description_ A ccount Number Cst Cnt Descrip Account Numbe Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 25.50 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 03/16/10 14:14:58 by LVA FEES CHANGED ON CANCELLED ITEMS 25.50
NET AMOUNT FROM CANCELLED ITEMS 25.50
TOTAL AMOUNT REFUNDED 25:50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 25.50 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
issue o cash or credit card refunds.
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Authorized ature D to Aut orized Signature Date
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Page 9 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.
Ansari, Shehzadi Terms
12517 Pembrooke Circle Date Due
Carmel, IN 46032
t
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/16/10 401144 Refund 25.50
Total 25.50
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Ansari, Shehzadi Allowed 20
12517 Pembrooke Circle
Carmel, IN 46032
In Sum of
25.50
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1096 -41 401144 4358400 25.50 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
25.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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