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Home My WebLink About188000 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 364433 Page 1 of 1 ONE CIVIC SQUARE TRISH PESYNA CHECK AMOUNT: $56.00 `4 1 CARMEL, INDIANA 46032 3686 BRUMLEY WAY CARMEL IN 46033 CHECK NUMBER: 188000 CHECK DATE: 7/21/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1092 4358400 466771 56.00 REFUNDS AWARDS INDE PASS REFUND RECEIPT Receipt 466771 Payment Date: 07107110 Household 3065 Moron Community Center Trish Pesyna Hm Ph: (317)815 -9171 Carmel IN 46032 3686 Brumley Way Wk Ph: (317) Carmel IN 46033 Cell Ph: (317)614 -5519 kpesyna @indy.rr.com Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Pass Details CANCELLATION Refund Of 56.00 Pass Holder: Ken Pesyna Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: FIT Adlt Mnthly (XM FTAM), #83773 96.00 0.00 0.00 96.00 0.00 Valid Dates: 10/06/2009 to 10/06/2010 Pass Cance Cancel Reason: guest states pass should have been cancelled in Jan. we are researching for paperwork. pass was not billed feb &mar. started getting billed in April 2010. refunding April May payments. The following item reflects a payment towar s a previous receipt Pass Holder: Derek Pesyna Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: FIT Adlt Mnthly (XM FTAM), #68764 60.00 0.00 40.00 20.00 0.00 Valid Dates 05/24/2009 to 05/2412010 Pass Cancellation) PREVIOUS NET HOUSEHOLD BALANCE 20.00 Processed on 07/07110 16:37:18 by TLP FEES CHANGED ON CANCELLED ITEMS 172.00 SURCHARGE APPLIED AGAINST CANCELLED FEES 96.00 NET AMOUNT FROM CANCELLED ITEMS FEES ADJUSTED ADJUSTED ON CHANGED ITEMS 0.00 qM r('t 74 gt n NET AMOUNT FROM CHANGED ITEMS 0.00 U JUL 1 4 20 10 F HH BALANCE APPLIED TO THIS RECEIPT(,) 20.00 V TOTAL AMOUNT REFUNDED 56.00 BY. NEW NET HOUSEHOLD BALANCE 0.00 Refund of 56.00 Made By REFUND FINAN With Reference Payment of 20.00 Made By Pass Management Credit Balance All refunds are subject to S, a e oard rAunts claim procedure and may take 4 -6 weeks to process. A check will be issued. No cash or credit and fund SigVtur ate Authorized Signature Date 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. Pesyna, Trish Terms 3686 Brumley Way Date Due Carmel, IN 46033 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 7/7110 466771 Refund 56.00 Total 56.00 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- 10 -1.6 20 Clerk- Treasurer Voucher No. Warrant No. Pesyna, Trish Allowed 20 3686 Brumley Way Carmel, IN 46033 In Sum of$ 56.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #ITITLE AMOUNT Board Members Dept 1092 466771 4358400 56.00 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 15 -Jul 2010 /50'W Dio)Vm Signature 56.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund