188106 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 362769 Page 1 of 1
ONE CIVIC SQUARE YAOYU WANG
CARMEL, INDIANA 46032 14318 CHARIOTS WHISPER DRIVE CHECK AMOUNT: $384.00
WESTFIELD IN 46074 CHECK NUMBER: 188106
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 466547 384.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 466547
Payment Date: 07/07/10
Household 6486
Monon Community Center Yaoyu Wang Hm Ph: (317)819 -5188
Carmel IN 46032 14318 Chariots Whisper Dr
Westfield IN 46074 Cell Ph: (317)509 -8396
cynthiawangO9@yahoo.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 143.00
Pass Holder. Colin Wang Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Nov Month PM (ESEMNP), #87454 0.00 0.00 0.00 0.00 0.00
Valid Dates: 11/02/2009 to 12/04/2009 Pass Cancellation)
Cancel Reason: change in employment status (opted into drop -in visits)
CANCELLATION Refund Of 241.00
Pass Holder: Helen Wang Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Nov Month PM (ESEMNP), #87455 0.00 0.00 0.00 0.00 0.00
Valid Dates: 11/02/2009 to 12/04/2009 Pass Cancellation)
Cancel Reason change in employment status (opted into drop -in visits)
The following item reflects a payment towards a previous receipt
Pass Holder: Colin Wang Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type Drop -In Visit (ESEDROP), #111457 56.00 0.00 0.00 56.00 0.00
Valid Dates: 08/10/2010 to 05/26/2011 Pass Change)
Pass visit Info: Number of Visits: 1
The following item reflects a payment towards a previous receipt
Pass Holder: Helen Wang Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Drop In Visit (ESEDROP), #111459 42.00 0.00 0.00 42.00 0.00
Valid Dates: 08110/2010 to 05/26/2011 Pass Change)
Pass visit Info: Number of Visits: 1
PREVIOUS NET HOUSEHOLD BALANCE 98.00
Processed on 07107/10 15:12:11 by BJJ FEES CHANGED ON CANCELLED ITEMS 482.00
NET AMOUNT FROM CANCELLED ITEMS 482.00.
FEES ADJUSTED ON CHANGED ITEMS 0.00
NET AMOUNT FROM CHANGED ITEMS 0.00
HH BALANCE APPLIED TO THIS RECEIPT 98.00
TOTAL AMOUNT REFUNDED 384.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 384.00 Made By REFUND FINAN With Reference
Page 1
J�/ )II
PASS REFUND RECEIPT
Receipt 466547
Payment Date: 07/07/2010
Household 6486
Payment of 98.00 Made By Pass Management Credit Balance
All refunds,gre subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued,,N6 or credit card refunds.
A hori� ure Date Authorized Signature Date
1T P 1 5,77
JUL
Bya ..........o
Page 2
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.
Wang, Yaoyu Terms
14318 Chariots Whisper Dr Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7!7110 466547 Refund 384.00
Total 384.00
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.
Wang, Yaoyu Allowed 20
14318 Chariots Whisper Dr
Westfield, IN 46074
In Sum of
384.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #ITITLE AMOUNT Board Members
Dept
1081 -3 466547 4358400 384.00 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
Signature
384.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund