189704 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 364695 Page 1 of 1
ONE CIVIC SQUARE SARAH BURKMAN CHECK AMOUNT: $20.00
CARMEL, INDIANA 46032 10853 GATE CIRCLE
FISHERS IN 46038 CHECK NUMBER: 189704
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 20.00 PARKS DEPARTMENT REFU
r
PASS REFUND RECEIPT
Receipt 511425
Payment Date: 08123110
Household 35450
Monon Community Center Sarah Burkman
Carmel IN 46032 10853 Gate Circle
Fishers IN 46038 Cell Ph: (317 )418 -6971
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 20.00
Pass Holder: Sarah BUrkman Fees +Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: UnGpFt MCAYSMIy (M UGFTMM), #109435 40.00 0.00 40.00 0.00 0.00
Valid Dates: 0610812010 to 06/08/2011 Pass Cancellation}
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/23/10 13:38:05 by TLP
FEES ADJUSTED ON CHANGED ITEMS 20.00
NET AMOUNT FROM CHANGED ITEMS TOTAL AMOUNT AMOUNT REFUNDED 20.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 20.00 Made By REFUND With Reference
All refundW.e subject. 0 St to Boa d f counts claim procedure and may take 4 -6 weeks to process. A check will be
issed.,Nb cash or credit c rd ref
Date Authorized Signature Date
Authorized Signal a II ��"`L� yg
ENJOY YOUR ESCAPE!!!
0 7 2010
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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.
Burkman, Sarah Terms
10853 Gate Circle Date Due
Fishers, IN 46038
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8123110 511425 Refund 20.00
Total 20.00
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.
Burkman, Sarah Allowed 20
10853 Gate Circle
Fishers, IN 46038
In Sum of
20.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or. INVOICE NO. ACCT /TITLE AMOUNT Board Members
Dept
1096 -22 511425 4358400 20.00 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
9 -Sep 2010
&A&M pru"�
Signature
20.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund