187439 07/07/2010 a CITY OF CARMEL, INDIANA VENDOR: 364324 Page 1 of 1
ONE CIVIC SQUARE CAREY SCURRIA
CARMEL, INDIANA 46032 209 BLAIRSDEN AVE CHECK AMOUNT: $201.37
CARMEL IN 46032
CHECK NUMBER: 187439
CHECK DATE: 717/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 457942 201.37 REFUNDS AWARDS INDE
Y
i
s.
PASS REFUND RECEIPT
Receipt# 457942
Payment Date: 06/30/10
Household 16992
Monon Community Center Carey Scurria Hm Ph: (317)569 -0233
Carmel IN 46032 209 Blairsden Ave Wk Ph: (317)899 -4050
Carmel IN 46032 Cell Ph: (317)522-3457
cscurria @hotmail.com
Phome: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 201.37
Pass Holder: Carey SCurria Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: UnGrpFit Annual (M UGFA), #59406 98.63 0.00 0.00 98.63 0.00
Valid Dates: 03/02/2010 to 03/02/2011 Pass Cancellation)
Cancel Reason upgraded to household pass with includes the unlimited fitness pass.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/30/10 11:12:06 by TLP FEES CHANGED ON CANCELLED ITEMS 300.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 98.63
NET AMOUNT FROM CANCELLED ITEMS 201.37-
TOTAL AMOUNT REFUNDED 201.37
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 201.37 Made By REFUND FI With Reference
All refunds are Ibject to St oard is claim procedure and may take 4 -6 weeks to process. A check will be
issued. ash or credit r refu
�v
Authorized Signatur Date Authorized Signature Date
JUL 0 2 2011
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.
Scurria, Carey Terms
209 Blairsden Ave Date Due
Carmel, In 46032
Invoice I Description
Date
;;;tached invoices) or bill(s)) Amount
201.37
6130110
Total 201.37
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.
Scurria, Carey Allowed 20
209 Blairsden Ave
Carmel, In 46032
In Sum of
201.37
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -22 457942 4358400 201.37 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
2 -Jul 2010
Signature
201.37 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund