HomeMy WebLinkAbout194339 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 365055 Page 1 of 1
0 ONE CIVIC SQUARE AMANDA SALFITY CHECK AMOUNT: $64.50
CARMEL, INDIANA 46032 7370 PEBBLEBROOKE WEST DRIVE
INDIANAPOLIS IN 46236 CHECK NUMBER: 194339
CHECK DATE: 2/312011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 64.50 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 568260
Payment Date: 01/28/11
Household 16537
Morton Community Center Amanda Salfity Hm Ph: (317)937 -8689
Carmel IN 46032 7370 Pebblebrooke W. Dr.
Indianapolis IN 46236 Cell Ph:
amanda.salfity yahoo.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 64.50
Pass Holder: Adrianna Huston Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: KZ 50 Visit (M Z50), #23403 10.50 0.00 10.50 0.00 0.00
Valid Dates: 04/15/2008 to 12/31/2099 Pass Cancellation)
Pass Visit info: Number of Visits: 43
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 01/28111 09:23:49 by LVA FEES CHANGED ON CANCELLED ITEMS 64.50
NET AMOUNT`:FROM CANCELLED ITEMS:. -64.50-
TOTAL AMOUNT REFUNDED 64.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 64.50 Made By REFUND FINAN With Reference prorated request
All refu s are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issu cash or credit card refunds.
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Authorized Sig re Date ,y iz�nature Date
Mothers, bring your little prince to Prince Charming's Ball and share a Valentine's evening of enchantment and wonder at this
ballroom -style event. The event will be held on Friday, February 4 from 6 -9pm at the MCC. Fee is $15 /person. Register at
www.carmelclayparks.com. Pre registration is required (activity# 319047 -01).
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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.
Salfity, Amanda Terms
7370 Pebblebrooke W. Dr. Date Due
Indianapolis, IN 46236
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/28111 568260 Refund 64.50
Total 64.50
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.
Salfity, Amanda Allowed 20
7370 Pebblebrooke W. Dr.
Indianapolis, IN 46236
In Sum of
64.50
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -41 568260 4358400 64.50 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
31 -Jan 2011
C2Z
Signature
64.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund