189447 08/31/2010 C�• CITY OF CARMEL, INDIANA VENDOR: 364643 Page 1 of 1
ONE CIVIC SQUARE SHELLY NAUM
CARMEL, INDIANA 46032 14391 QUAIL POINTE DRIVE CHECK AMOUNT: $41.00
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CARMEL IN 46032 CHECK NUMBER: 189447
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 41.00 PARKS DEPARTMENT REFU
m
PASS REFUND RECEIPT
Receipt# 511827
Payment Date: 08/24110
Household 6936
Monon Community Center Shelly Naum Hm Ph: (317)571 -8979
Carmel IN 46032 14391 Quail Pointe Drive
Carmel IN 46032 Cell Ph: (317)442 -1185
snaum @indy.rr.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION
Pass Holder: Allison Naum Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: UnGrpFit Annual (M UGFA), #85002 234.00 0.00 0.00 234.00 0.00
Valid Dates: 10/17/2009 to 1 011 7/201 0 Pass Cancellation)
Cancel Reason: going back to school
CANCELLATION Refund Of 41.00
Pass Holder: Allison Naum Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: FIT Adlt Mnthly (XIVI FTAM), #93875 224.00 0.00 0.00 224.00 0.00
Valid Dates: 01/05/201 to 011141 Pass Cancellation)
Cancel Reason: going back to school
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08124!10 15:0623 by TLP FEES CHANGED ON CANCELLED ITEMS 499.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 458.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 41.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 41.00 Made B e y REFUND F.I. 1 With Reference
All refunds are subject tpp''St��nCe Boar 6nts claim procedure and may take 4 -6 weeks to process. A check will be
iss o c sh or cr dit,eard refucftls
uthorized Sign ure Date Authorized Signature Date
ENJOY YOUR ESCAPE!!! j Xv-9-JOIRT131
AUG 2 5 2010
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,
Naum, Shelly Terms
14391 Quail Pointe Drive Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number
or note attached invoices} or bili(s)) Amount
41.00
8124/10 511827 ERefund
Total 41.00
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.
Naum, Shelly Allowed 20
14391 Quail Pointe Drive
Carmel, IN 46032
In Sum of
41.00
ON ACCOUNT OF APPROPRIATION FOR
I
109 Monon Center
PO# or Board Members
Dept INVOICE NO. ACCT #/TITLE AMOUNT
1096 -22 511827 4358400 41.00 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
26 -Aug 2010
PA4bWj&
Signature
41.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund