192799 12/15/2010 CITY OF CARMEL, INDIANA VENDOR: 364935 Page 1 of 1
ONE CIVIC SQUARE HEATHER DUBBELS
CHECK AMOUNT: $157.81
9559 GRINNELL STREET
CARMEL, INDIANA 46032
INDIANAPOLIS IN 46268 CHECK NUMBER: 192799
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CHECK DATE: 12/15/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 157.81 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 546273
Payment Date: 12/08/10
Household 35796
Monon Community Center Heather Dubbels Hm Ph: (419)439 -2321
Carmel IN 46032 9559 Grinnell St
Indianapolis IN 46268 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 157.81
Pass Holder. Heather Dubbels Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type. UnGrpFit Annual (M UEFA), #110230 142.19 0.00 0.00 142.19 0.00
Valid Dates: 0611812010 to 06/18/2011 Pass Cancellation)
Cancel Reason: Does not get used
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 12/08/10 11:23:35 by MJN FEES CHANGED ON CANCELLED ITEMS 300.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 142.19
1 s NET AMOUNT FROM CANCELLED ITEMS 157.81-
1 1 TOTAL AMOUNT REFUNDED 157.81
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 157.81 Made By REFUND FINAN With Reference
All refunds are subject to State Board of Accounts claim procedure and may to weeks to process. A check will be
issued. No or credit card refunds.
Authorized Signature Date Au a ignatur Date
DEC 0 9 2010
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,
Dubbels, Heather Terms
9559 Grinnell St Date Due
Indianapolis, IN 46268
Invoice Invoice Description
Date Number (or note attached invoicjor s)) A mount
1218110 546273 Refund 157.81
Total 157.81
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordbnce
with IC 5- 11- 10 -1.6
20,
Clerk- Treasurer
Voucher No. Warrant No.
Dubbels, Heather Allowed 20
9559 Grinnell St
Indianapolis, IN 46268
In Sum of
157.81
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #(TITLE AMOUNT Board Members
Dept
1096 -22 546273 4358400 157.81 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 -Dec 2010
Signature
157.81 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund