161962 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: 361624 Page 1 of 1
ONE CIVIC SQUARE JEFF MOSLEY
CARMEL, INDIANA 46032 10386 POWER DRIVE CHECK AMOUNT: $87.00
CARMEL IN 46033 CHECK NUMBER: 161962
CHECK DATE: 7/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 87.00 PARKS DEPARTMENT REFU
M1
PASS REFUND RECEIPT
Receipt 154873
Payment Date: 07/16/2008 JUL 1 2008
Household 8177
Home Phone: (317)810 0679,,,
Work Phone: (317)578 -4511
JEFF MOSLEY Monon Center
10386 POWER DRIVE Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 87.00
Pass Holder: Jeff Mosley Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prem. Yrly HH R (PRMYRHHR), #6763 0.00 0.00 0.00 0.00 0.00
Valid Dates: 06/05/2008 to 06/06/2009 Pass Cancellation)
Cancel Reason: No longer members.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/16/08 16:44:46 by EMB FEES CHANGED ON CANCELLED ITEMS 87.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS 87.00
TOTAL AMOl1NT REFUNDED 87.00
NEW NET HOUSEHOLD BALANCE 0.00
R d of 87.00 m==> CHECK With Reference check
P Uthorized Signature Date Authorized Signature Dale
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.
Mosley, Jeff Terms
10386 Power Drive Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/16108 154873 Refund 87.00
Total 87.00
I 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.
Mosley, Jeff Allowed 20
10386 Power Drive
Carmel, IN 46033
In Sum of
87.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 154873 4358400 87.00 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
18 -Jul 2008
O
Signature
87.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund