189102 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 364545 Page 1 of 1
0 ONE CIVIC SQUARE ELLEN SEIFFERT CHECK AMOUNT: $28.00
CARMEL, INDIANA 46032 21 SPENCER ST. #413
LEBANON NH 03766 CHECK NUMBER: 189102
CHECK DATE: 8/18/2010
DEPARTMENT ACCOUNT PO NUMBER IN NUMBER AMOUNT DESCRIPTION
1092 4358400 28.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt Al 502350
Payment Date: 08/11/10
Household 33699
Monon Community Center Ellen Seiffert
Carmel IN 46032 21 Spencer Street #413
Lebanon NH 03766 Cell Ph: (847)420 -2360
ellenaseiffert @gmail.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 28.00
Pass Holder: Ellen Seiffert Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: FIT Adlt Mnthly (XM FTAM), #100635 84.00 0.00 0.00 84.00 0.00
Valid Dates: 03/02/2010 to 01/14/2011 Pass Cancellation)
Cancel Reason: moved.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/11/10 14:46:04 by TLP FEES CHANGED ON CANCELLED ITEMS 112.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 84.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 28.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 28.00 Made By R U FINAN With Reference
All refunds are bjec o ate oar Accounts laim rocedure and may take 4 -6 weeks to process. A check will be
issued o -c s� h or cr di ar u
t
f
A ho zed Si a Date Authorized Signature Date
ENJOY YOUR ESCAPE! 7-- `r
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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.
Seiffert, Ellen Terms
21 Spencer Street 413 Date Due
Lebanon, NH 03766
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8111110 502350 Refund 28.00
Total 28.00
I 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.
Seiffert, Ellen Allowed 20
21 Spencer Street 413
Lebanon, NH 03766
In Sum of
28.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT#rT]TLE AMOUNT Board Members
Dept
1092 502350 4358400 28.00 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
12 -Aug 2010
/UaP"Y�/
Signature
28.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund