155270 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