187438 07/07/2010 CITY OF CARMEL, INDIANA VENDOR: T360410 Page 1 of 1
ONE CIVIC SQUARE JACQUELYNNE SCHLIEPER
CARMEL, INDIANA 46032 585 BORDERWOOD LANE CHECK AMOUNT: $61.50
CARMEL IN 46032 CHECK NUMBER: 187438
CHECK DATE: 7/7/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOU DESC RIPTION
1096 4358400 449673 61.50 REFUNDS AWARDS INDE
1
PASS REFUND RECEIPT
Receipt 449673
Payment Date: 06/21/10
Household 12923
Monon Community Center Jacquelynne Schlieper Hm Ph: (317)810 -0016
Carmel IN 46032 585 Bolderwood Lane Wk Ph: (317)376 -0920
Carmel IN 46032 Cell Ph:
I jackieo_iam @yahoo.ca
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 61.50
Pass Holder: Jacquelynne Schlieper Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: KZ 50 Visit (M Z50), #37706 13.50 0.00 13.50 0.00 0.00
Valid Dates: 08/30/2008 to 12/31/2099 Pass Cancellation)
Pass visit Info: Number of Visits: 41
Cancel Reason: pro -rated request
G /L_ Code Des_cription____ Account Numbe_r____ Csl Cntr____ Description Account_Number___..
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 61.50 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 06/21/10 16:20:26 by LVA FEES CHANGED ON CANCELLED ITEMS 61.50
NET AMOUNT FROM CANCELLED ITEMS 61.50-
TOTAL AMOUNT REFUNDED 61.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 61.50 Made By REFUND FINAN With Reference pro -rated 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 o cash or credit card refunds.
to _a4ow WIWI /aW/()
Authorized Signal r Date Auth rized Signature Date
JUN 2 3 2010
Page 41 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.
Terms
Schlieper, Jacquelynne Date Due
585 Bolderwood Lane
Carmel, IN 46032
Invoice Invoice
Description Amount
Date Number (or note attached invoice(s) or bill(s)) 61,50
6/21110 449673 Refund
Total 61.50
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
20
Clerk- Treasurer
Voucher No. Warrant No.
Schlieper, Jacquelynne Allowed 20
585 Bolderwood Lane
Carmel, IN 46032
In Sum of
4
61.50
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or Board Members
Dept INVOICE NO. ACCT #/TiTLE AMOUNT
1096 -41 449673 4358400 61.50 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
1 -Jul 2010
Signature
61.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund