189054 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 364553 Page 1 of 1
ONE CIVIC SQUARE ROBERT VEENSTRA CHECK AMOUNT: $110.00
CARMEL, INDIANA 46032 4565 ST JOHN CIRCLE
ZIONSVILLE IN 46077 CHECK NUMBER: 189054
CHECK DATE: 8/1812010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 492220 40.00 REFUNDS AWARDS INDE
1094 4358400 500783 70.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 492220
Payment Date: 08/02/10
Household 36234
Monon Community Center Robert Veenstra Hm Ph: (317)873 -9798
Carmel IN 46032 4656 St John Circle
Zionsville IN 46077 Cell Ph:
Phone: (317)848-7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION
Pass Holder: Robert Veenstra Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Seas AQ Seniorr (SAQSR), #111589 35.00 0.00 0.00 35.00 0.00
Valid Dates: 05/29/2010 to 09/06/2010 Pass Cancellation)
Cancel Reason: per guest "to crowded /didnt like it"
CANCELLATION Refund Of 40.00
Pass Holder: Lianie Veenstra Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Seas AQ Seniorr (SAQSR), #111590 35.00 0.00 0.00 35.00 0.00
Valid Dates: 05/29/2010 to 09/06/2010 Pass Cancellation)
Cancel Reason: per guest "to crowded didnt like it"
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/02/10 11:20:45 by TLP FEES CHANGED ON CANCELLED ITEMS 110.00-
SURCHARGE APPLIED AGAINST CANCELLED FEES 70.00-
I NET AMOUNT FROM CANCELLED ITEMS 40.00
TOTAL AMOUNT REFUNDED 40.00
t
i v NEW NET HOUSEHOLD BALANCE 0.00
Refund of 40.00 Made By FUND FINA eference
All refunds are subject to S to B rd of s c im procedure and may take 4 -6 weeks to process. A check will be
issued.aeh�'redit and r unds.
A thorized Signature Date Authorized Signature Date
Enjoy your escape at the MCC.
Page 1
PASS REFUND RECEIPT
Receipt# 500783
Payment Date: 08/09/10
Household 36234
Carmel Clay Parks Recreation Robert Veenstra Hm Ph: (317)873 -9798
1235 Central Park Drive East 4656 St John Circle
Carmel IN 46032 Zionsville IN 46077 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 35.00
Pass Holder: Robert Veenstra Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Seas AQ Seniorr (SAQSR), #111589 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/29/2010 to 09/06/2010 Pass Cancellation)
CANCELLATION Refund Of 35.00
Pass Holder: Lianie Veenstra Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Seas AQ Seniorr (SAQSR), #111590 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/29/2010 to 09/0612010 Pass Cancellation)
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/09/10 14:50:23 by ASK FEES CHANGED ON CANCELLED ITEMS 70.00
NETiAMOU NT FROM 'CANCELLED.ITEMS 1Oc00-
"TOTALAMOUNT REFUNDED 70.00.
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 70.00 Made By REFUND FINAN With Reference per S.Beaurain
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 ca h or credit.card refunds.
(D
Authorize ignat re Date Authorized Signature Date
ENJOY YOUR ESCAPE!
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.
Veenstra, Robert Terms
4656 St. John Circle Date Due
Zionsville, IN 46077
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
812110 492220 Refund 40.00
819110 500783 Refund 70.00
Total 110.00
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.
Veenstra, Robert Allowed 20
4656 St. John Circle
Zionsville, IN 46077.
In Sum of
110.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 492220 4358400 40.00 1 hereby certify that the attached invoice(s), or
1094 500783 4358400 70.00 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
110.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund