HomeMy WebLinkAbout185271 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 364122 Page 1 of 1
t ONE CIVIC SQUARE ROBERT HAAG
CARMEL, INDIANA 46032 10461 WOODLAWN DR CHECK AMOUNT: $36.00
INDIANAPOLIS IN 46280
>o� CHECK NUMBER: 185271
CHECK DATE: 511 112 01 0
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 415762 36.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 415762
Payment Date: 04/29/10
Household 12702
Carmel Clay Parks Recreation Robert Haag Hm Ph: (317)844 -5268
1235 Central Park Drive East 10461 Woodlawn Dr
Carmel IN 46032 Indianapolis IN 46280 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 36.00
Pass Holder: Robert Haag Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Senr Mthly (M MCSM), #104958 136.00 0.00 136.00 0.00 0.00
Valid Dates: 04/29/2010 to 04/29/2011 Pass Change)
GIL Code Description Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 36.00 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 04/29/10 13:33:42 by ABK FEES ADJUSTED ON CHANGED ITEMS 36.00
RNET°AMOUNT`FROM;CHANGED -ITEMS 36.00=
3TOTAL"AMOUNTREFUNDED-
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 36.00 Made By REFUND FINAN With Reference Over pd; Senior
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 cr dit card refunds.
Autho zed Si ature Dale Authorized Signature Date
.r
APR
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.
Haag, Robert Terms
10461 Woodlawn Dr Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4129110 416762 Refund 36.00
Total 36.00
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- 1046
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Haag, Robert Allowed 20
1 Woodlawn Dr
Indianapolis, IN 46280
In Sum of
36.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #rrlTLE AMOUNT Board Members
Dept
1092 415762 4358400 36.00 l 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
5 -May 2010
Signature
36.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund