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Home My WebLink About155270 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 360697 Page 1 of 1 ONE CIVIC SQUARE BETH DICKSON CHECK AMOUNT: $17.01 CARMEL, INDIANA 46032 6437 BAYSIDE CT INDPLS IN 46250 CHECK NUMBER: 155270 CHECK DATE: 111012008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1047 4358400 79750 17.01 REFUNDS AWARDS INDE PASS SALES RECEIPT Receipt 79750 Payment Date: 12/27/2007 Household 8671 Home Phone: (317)688 -2164 Work Phone: c CLARIAN NORTH Monon Center 11700 N. MERIDIAN Carmel IN 46032 CARMEL, IN 46032 Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Pass Details CANCELLATION Refund Of 17.01 Pass Holder: Beth Dickson Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Prem. Yrly Sr R (PRMYRSR), #10209 101.99 0.00 101.99 0.00 0.00 Valid Dates: 06/24/2007 to 06!2412008 Pa Ga cell ation) Fee Details: Fee Des Amount Count Discount Sales Tax Total Fee Prem. Yrly Senior Re 101.99 1.00 0.00 0.00 101.99 Cancel Reason: not using pass The following item reflects a payment towards a previous receipt Pass Holder: Christopher Wood Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Corp.Pass YA (CORPA) #11053 30.40 0.00 29.81 0.00 0.59 Valid Dates: 07/04/2007 to 07/04/2007 Pass Change) Fee Details: Fe Descri Amount Co unt Discount Sales Tax Total Fee Corp. Adult 5 -19 30.40 1.00 0.00 0.00 30.40 The following item reflects a payment towards a previous receipt Pass Holder: Samantha Ferguson Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Prem. Yrly Ad R (PRMYRADR), #11080 54.40 0.00. 54.40 0.00 0.00 Valid Dates: 07/04/2007 to 07/04/2008 Pass Cancellation) Fee Details: Fee Description Amount Count Disco Sales Tax Total Fee Prem. Yearly Adult R 54.40 1.00 0.00 0.00 54.40 Processed on 12/27/07 16:14:07 by EDR REVISED FEES ON EXISTING LINE ITEMS 17.01 REVISED DISCOUNT APPLIED AGAINST FEES 0.00 TAX CHARGED ON REVISED FEES NEWaAMOUNT DUE;;':: "z,. 17 01. PREVIOUS NET HOUSEHOLD BALANCE {3 TOTAL;DUE 87:34: REVISED FEES PAID ON THIS RECEIPT 0.00 TOTAC�PAID, ,:0'UO Page 1 PASS SALES RECEIPT Receipt 79750 Payment Date: 12/27/07 Household 8671 NEW NET HOUSEHOLD BALANCE 87.34 Amount: 17.01 Payment Type: Pass Management Credit Balance Page 2 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. Beth Dickson Terms 6437 Bayside Court Date Due Indianapolis, IN 46250 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12127/08 79750 Refund 17.01 Total 17.01 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 1 20 Clerk- Treasurer Voucher No. Warrant No. Beth Dickson Allowed 20 6437 Bayside Court Indianapolis, IN 46250 In Sum of 17.01 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1047 79750 4358400 17.01 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 4 -Jan 2008 ag n ur 17.01 Business Services Manager Cost distribution ledger classification if Title claim paid motor vehicle highway fund