HomeMy WebLinkAbout188038 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 364438 Page 1 of 1
ONE CIVIC SQUARE DAVID ROSS CHECK AMOUNT: $56.00
CARMEL, INDIANA 46032 1059 SARATOGA CIRCLE
INDIANAPOLIS IN 46280 CHECK NUMBER: 188038
CHECK DATE: 7121/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 477219 56.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 477219
Payment Date: 07116!10
Household 10573
Manon Community Center David Ross Hm Ph (317)403 -7080
Carmel IN 46032 1059 Saratoga Circle
Indianapolis IN 46280 Cell Ph:
dross @indy.rr.com
Phone: (317)848 -7275
Fed Tax I D #35- 6000972
Pass Details
CANCELLATION Refund Of 56.00
Pass Holder: David Ross Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: FIT Adlt Mnthly (XM FTAM), #12399 84.00 0 -00 0.00 84.00 0.00
Valid Dales: 02126!2010 to 01114!2011 (Pass_Cance�lation
Cancel Reason: cancelled per a phone call from guest. guest called before the july billing`
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07116110 12:22:58 by TLP FEES CHANGED ON CANCELLED ITEMS 140.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 84.00
NET AMOUNT FROM CANCELLED ITEMS 56.00
TOTAL AMOUNT REFUNDED 56.00
NEW NET HOUSEHOLD BALANCE 0 -00
Refund of 56.00 Made By REFUND INA, Wilh Reference
All refunds are subject to,,S)a e Bo td of counts claim proce tire and may take 4 -6 weeks to process. A check will be
issued. cas )r credit card ref n
J Authoriz d Signalu a ate Authorized Signature Date
Enjoy your escape at the MCC.
LLIP ire,
JUL 16 2010
t
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.
Ross, David Terms
1059 Saratoga Circle Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7116110 477219 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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Ross, David Allowed 20
1059 Saratoga Circle
Indianapolis, IN 46280
In Sum of
�5
56.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 477219 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
Signature
56.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund