189307 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 364635 Page 1 of 1
ONE CIVIC SQUARE MARIANN DAVIS
CARMEL, INDIANA 46032 13120 HAZELWOOD COURT CHECK AMOUNT: $35.00
CARMEL IN 46033 CHECK NUMBER: 189307
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 35.00 REFUNDS AWARDS INDE
r PASS REFUND RECEIPT
Receipt 509564
Payment Date: 08/19/10
Household /SSJ
Carmel Clay Parks Recreation I t Qi r Ol n n ba V I S Hm Ph: (317)733 -1768
1235 Central Park Drive East Ze UcQ
Carmel IN 46032 I� �a Cell Ph:
Phone: (317)848 7275 t4 0,3
3
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 35.00
Pass Holder: Timothy Davis Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Adlt Mthly (M MCAM), #94585 0.00 0.00 0.00 0.00 0.00
Vaud Dates: 07/29/2010 to 08/31/2011 Pass Change)
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 0$!19/10 09:27:53 by ABK FEES ADJUSTED ON CHANGED ITEMS 35.00
NET:'AMOUNT FROM CHANGED ITEMS 35.00
TOTAL,AMOUNT;REFUNDED 35.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 35.00 Made By REFUND FINAN With Reference Wrong HH
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.
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Authorized SI n ure Dale Authorized Signature Date
ENJOY YOUR ESCAPE!!!
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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.
Davis, Mariann Terms
13120 Hazelwood Ct Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8119110 509564 Refund 35.00
Total 35.00
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,
Davis, Mariann Allowed 20
13120 Hazelwood Ct
Carmel, IN 46033
In Sum of
35.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 509564 4358400 35.00 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
26 -Aug 2010
Signature
35.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund