HomeMy WebLinkAbout196886 04/26/2011 CITY OF CARMEL, INDIANA VENDOR: 365244 Page 1 of 1
0 ONE CIVIC SQUARE GILBERT O'BRYANT CHECK AMOUNT: $221.00
CARMEL, INDIANA 46032 13865 FERNLEAF WAY
CARMEL IN 46033 CHECK NUMBER: 196886
CHECK DATE: 4126/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 221.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 606900
Payment Date: 04/20/11
Household 24350
Monon Community Center Gilbert O'bryant Hm Ph: (317)569 -0295
Carmel IN 46032 13865 Fernleaf Way Wk Ph: (317)
Carmel IN 46033 Cell Ph: (317)402-8739
Phone: (317)848 -7275 a.obryant @sbcglobal.net
Fed Tax ID #356000972
Pass Details
CANCELLATION Refund Of 104.00
Pass Holder: Danny O'bryant Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 10 -Visit (ESE10V), #117111 26.00 0.00 26.00 0.00 0.00
Valid Dates: 08/10/2010 to 05/26/2011 Pass Cancellation)
Pass visa Info: Number of Visits: 8
Cancel Reason: no longer need ese
CANCELLATION Refund Of 117.00
Pass Holder: Brock Sabo Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 10 -Visit (ESE10V), #117112 1100 0.00 13.00 0.00 0.00
Valid gates: 08/10/2010 to 05/26/2011 Pass Cancellation)
Pass Visit Info: Number of Visits: 9
Cancel Reason: no longer need ese
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 04/20111 10:3527 by BJJ FEES CHANGED ON CANCELLED ITEMS 221.00-
NET:AMOUNTfROMCANCELLMITEMS 221:00-!
TOTAL•AMOUNTs`REFUNDED 221:00;'.
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 221.00 Made By REFUND FINAN With Reference
All refunds re subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. N ash or credit rd refunds. qp4(-
A thori d Signature Date Authorized Signature Date
q3, 'lg APR 2 1 20i
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.
O'Bryant, Gilbert Terms
13865 Fernleaf Way Date Due
Carmel, I N 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4120111 606900 Refund 221.00
Total 221.00
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.
O'Bryant, Gilbert Allowed 20
13865 Fernleaf Way
Carmel, IN 46033
In Sum of
221.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -7 606900 4358400 221.00 I 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
21 -Apr 2011
Signature
221.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund