183648 03/25/2010 a CITY OF CARMEL, INDIANA VENDOR: 363996 Page 1 of 1
ONE CIVIC SQUARE DARLENE KLINGENSMITH
CHECK AMOUNT: $81.60
CARMEL, INDIANA 46032 19136 TOMLINSON ROAD
WESTFIELD IN 46074 CHECK NUMBER: 183648
CHECK DATE: 3/25/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 81.60 REFUNDS AWARDS INDE
i
PASS REFUND RECEIPT
Receipt 401137
Payment Date: 03/16/10
Household 30165
Monon Center Darlene Klingensmith Hm Ph: (317)896 -2675
Carmel IN 46032 19136 Tomlinson Road Wk Ph: (317)773 -6430
Westfield IN 46074 Ext. 2053
ddkling @verizon.com Cell Ph: (317)428 -8724
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 81.60
Pass Holder Darlene Klingensmith Fees +Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Corp 20 Adult (CORP 20A), #79538 76.80 0.00 0.00 76.80 0.00
Valid Dates: 08/25/2009 to 08/25/2010 Pass Cancellation)
Cancel Reason: pass cancelled in Dec. 09~
GIL Code Descrip Account Number Cst Cn lr Descri Account Number A
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 81.60 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 03116/10 13.34:21 by TLP FEES CHANGED ON CANCELLED ITEMS 158.40
SURCHARGE APPLIED AGAINST CANCELLED FEES O 76.80-
NET °AMOUNT4F.ROM;CANCELLED;ITEMS u 81160
,TOTAL REFUNDED,, u' gl%. I w... <81'60
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 81.60 Made By REFUXq FINAN With Reference
All refunds ar subjec Bo d �ccounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. cash or credit ca ref as
CL U
Au orized Signature Date Authorized Signature Date
MAkJ72
BY:.......................
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.
Klingensmith, Darlene Terms
19136 Tomlinson Rd. Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3116110 401137 Refund 81.60
Total 81.60
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.
Klingensmith, Darlene Allowed 20
19136 Tomlinson Rd.
Westfield, IN 46074
In Sum of
81.60
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1092 401137 4358400 81.60 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
JN41W 1 0/1�
Signature
81.60 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund