HomeMy WebLinkAbout197198 05/11/2011 CITY OF CARMEL, INDIANA VENDOR: 365271 Page 1 of 1
ONE CIVIC SQUARE MATTHEW GRANT
CARMEL, INDIANA 46032 3291 HAZEL FOSTER DR CHECK AMOUNT: $84.00
CARMEL IN 46033
CHECK NUMBER: 197198
CHECK DATE: 5/11/2011
DEPAR AC COUN T PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTIO
1081 4358400 84.00 REFUND
PASS REFUND RECEIPT
Receipt 609021
Payment Date: 04/27/11
Household 6335
Monon Community Center Matthew Grant Hm Ph: (317)439 -5850
Carmel IN 46032 3291 Hazel Foster Dr.
Carmel IN 46033 Cell Ph:
Phone: (317)848 -7275 andrea.grant @blueskytp.com
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 84.00
Pass Holder: Shard Grant Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 10 -Visit (ESE10V), #130184 26.00 0.00 26.00 0.00 0.00
Valid Dates: 08/10/2010 to 05/26/2011 Pass Cancellation)
Pass Visit Info: Number of Visits: 8
Cancel Reaso longer need ese
The following item owards a previous receipt
Pass Holder: Andrea Grant Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: FIT Adlt Mnthly (XM FTAM), #22085 80.00 0.00 60.00 20.00 0.00
Valid Dates: 03/12/2008 to 03/12/2009 Pass Cancellation)
PREVIOUS NET HOUSEHOLD BALANCE 20.00
Processed on 04/27/11 13:55:37 by BJJ FEES CHANGED ON CANCELLED ITEMS 104.00
NET AMOUNT FROM CANCELLED ITEMS
FEES ADJUSTED ADJUSTED ON CHANGED ITEMS 0.00
NET AMOUNT FROM CHANGED ITEMS 0:00
HH BALANCE APPLIED TO THIS RECEIPT 20.00
TOTAL AMOUNT REFUNDED 84.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 84.00 Made By REF FINA With Reference
Payment of 2.00 Made By Pass Management Credit Balance
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 cash or credit card refunds. r
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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.
Grant, Matthew Terms
3291 Hazel Foster Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4127111 609021 Refund 84.00
Total 84.00
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.
Grant, Matthew Allowed 20
3291 Hazel Foster Dr
Carmel, IN 46033
In Sum of
84.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO# or INVOICE NO. ACCT #(TITLE AMOUNT Board Members
Dept
1081 -1 609021 4358400 84.00 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
1 4 -May 2011
Signature
84.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund