HomeMy WebLinkAbout195472 03/16/2011 a CITY OF CARMEL, INDIANA VENDOR: 365168 Page 1 of 1
ONE CIVIC SQUARE NIKKI HOSEI CHECK AMOUNT: $55.00
CARMEL, INDIANA 46032 8215 SADDLE POINT DRIVE
INDIANAPOLIS IN 46256 CHECK NUMBER: 195472
CHECK DATE: 3/16/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 55.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 581313
Payment Date: 02/25/11
Household 19443
Monon Community Center Nikki Hose! Hm Ph: (317)413 -3315
Carmel IN 46032 �A�}- 8215 Saddle Point Dr
t� indianapolis IN 46256 Cell Ph:
nikkihosei@gmail.com (317 )848 -7275 ikkihosei @gmail.com
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION
Pass Holder Nikki Hosei Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Adlt Mthly (M MCAM), #120547 105.00 0.00 0.00 105.00 0 -00
Valid pates: 10/21/2010 to 10/21/2011 Pass Cancellation)
Cancel Reason: has become too expensive for now
CANCELLATION Refund Of 55.00
Pass Holder: Nikki HOsei Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: UnGpFt MCAYSMIy (M UGFTMM), #120548 60.00 0.00 0.00 60.00 0.00
Valid Dates: 10/21/20,10 -to •10/21/2011 _(Pass Cancellation)
Cancel Reason: has become too expensive for now
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 02/25111 10:39:16 by TLP FEES CHANGED ON CANCELLED ITEMS 220.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 165.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 55.00
„rr NEW NET HOUSEHOLD BALANCE D.00
Refund of 55.00 Made By >,REFUND FINAN With Reference
All refunds arersubjedt to St' to Bcard of Ace uts claim procedure and may tak -6 eks process. A check will be
issued —Nd cash or credit::" d' refunds.
x to r 4 Rzr Z Z S1 1 1
Authorized Si nature y- r
g Dale Auth r d Signat a Date
Sign up now or volunteer for our Dime Carnival taking place on March 5, from 6 -9pm in the MCC Banquet Rooms. There will
be at least 15 different types of games appropriate for ages 3 -12 years old. The number of tickets required to play varies for
each game. You may play your favorite game as often as you would like; just make sure you don't run out of tickets. Tickets
are 10 cents each, put you may purchase by the dollar. Visit carmelclayparks.com for ticket numbers and pricing.
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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.
Hosei, Nikki Terms
8215 Saddle Point Dr Date Due
Indianapolis, IN 46256
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2125111 581313 Refund 55.00
Total 55.00
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.
Hosei, Nikki Allowed 20
8215 Saddle Point Dr
Indianapolis, IN 46256
In Sum of
55.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 581313 4358400 55.00 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
10 -Mar 2011
Signature
55.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund