HomeMy WebLinkAbout189001 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 364547 Page I of 1
ONE CIVIC SQUARE JEREMY SINSABAUGH CHECK AMOUNT: $50.00
CARMEL, INDIANA 46032 5969 RAMSEY DRIVE
NOBLESVILLE IN 46062 CHECK NUMBER: 189001
CHECK DATE: 8/18/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4358400 495358 50.00 REFUNDS AWARDS INDE
FACILITY REFUND RECEIPT
Receipt 495358
Payment Date: 08/05/10
Household 35407
Monon Community Center Jeremy Sinsabaugh Hm Ph: (317)569 -1211
Carmel IN 46032 5969 Ramsey Drive Wk Ph: (317)213 -7868
Noblesville IN 46062 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Facility Reservation Details
CANCELLATION Refund Of 50.00
Facility: Inlow Park, Inlow South Shelter
Reserv. Contact: Holly Sinsabaugh, HM: (317)569 -1211
Reserv. Number: 13046 Status: Cancelled
Purpose: Birthday Party
Anticipated Count: 28
Date _D_ay Time Fees i Tax Discount Prev Paid Cur Paid Amount Due
0712.412010 Sat 4:30P to 7:00P 0.00 0.00 0.00 0.00 0.00
Cancel Reason: Water features were not working at Inlaw.
PREVIOUS NET HOUSEHOLD BALANCE 3.50
Processed on 08/05/10 12:41:24 by MCC FEES CHANGED ON CANCELLED ITEMS 50.00
SALES TAX CHARGED ON CANCELLED FEES 3.50
NET AMOUNT FROM CANCELLED ITEMS 53.50=
HH BALANCE APPLIED TO THIS RECEIPT 3.50
TOTAL AMOUNT REFUNDED 50.00
NEW NET HOUSEHOLD BALANCE. 0.00
Refund of 50.00 Made By REFUND FINAN With Reference check: features not working
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No cash or credit card refunds.
The count for this line item will not be known until after the reservation date. Therefore, both the count and the extension are
left at zero for reservation purposes, but will be updated after the reservation date. As soon as this data is available, you will
be invoiced for the current amount due. Please remit to our office within 10 days of the invoice date.
S -rte
Authorized Signature Dale Authorized Signature Dale
ENJOY YOUR ESCAPE!
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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.
Sinsabaugh, ,Jeremy Terms
5969 Ramsey Drvie Date Due
Noblesville, IN 46062
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
815110 495358 Refund 50.00
Total 50.00
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.
Sinsabaugh, Jeremy Allowed 20
5969 Ramsey Drvie
Noblesville, IN 46062
In Sum of
50.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1095 -3 495358 4358400 50.00 I 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
Signature
50.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund