178711 10/28/2009 *f CITY OF CARMEL, INDIANA VENDOR: 00350224 Page 1 of 1
ONE CIVIC SQUARE NANCY HECK CHECK AMOUNT: $112.17
CARMEL, INDIANA 46032
*r CHECK NUMBER: 178711
CHECK DATE: 10/28/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4355100 63.71 PROMOTIONAL FUNDS
1047 4358400 343727 48.46 REFUNDS AWARDS INDE
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MARSH CAFE
2140 E. 116TH STREET' MARSH SH CAFE I
CARMEL, IN 46032 2140 E. 116TH STREET
(317)575 °3650 CARMEL, IN 46032
{3173575-3650 2140 E 116TH STREET
SALAD BAR 6 rj iS CARMEL, IN 46032
99 HMORSG 1000 1:51_ANI) hg f3 9 ?7 DASANI 20' {317 )575 -3650
SALAD BAR 4q fi 65 DONUT
SALAD BAR B i 5991 DEANS SKIN [;HUG
Y` TAX 1 f3Rf_ 19,•11 001 DONUT ?.80 f 981 12 Q' COFPEI i9 T
7! 1
-ts TAX 06 8 L 1 fil
`f
0" 20 OZ DRINK DONUT
I RX &0 BAL Zl 8 86 20 OZ DRINK 1 F- TAX f_XFMP 1 111314 0[
r. T H H 10
x TAx 00 BAI- 1
TAX EXEMPT I [1N nU Fr,X LXEMP I f ON I'.!
x 1.AX J 1 3 TAX 00 BHT_ i:. t* 0 BFl
CID
TA OC� i1Fil_ 4 TA Oil t3AL �1J SIJPFRMARKI;:l 911
1T6TH SFREET
FN 46032
RSH SUPERMARKET 1111 RSH SUPERMARKET JI11 i75 -3650
10 E. 116Th STREFI 10 E. 116TH STREET
RMEL, IN 46032 P!JR E; HAS 10/1
E '5/09 IG CiL: !'M
!KNEE, IN 16032
:17)575 -3650 17)5'75 -3650
AQTH 0 1 5338 V
I V U R C H A S FI Jf;CNASE 1 1
i'AYMC:N F AMU1-IN I I
1IH:01552B iH.015946
YMLNF AMOUNT 19 'Jg iYMENT AMOUNT VF cRE1)11 Z _�l•;
CIIANGF UO
CREDIT 19.98 CRLDI1 8.1:5 TOTAL NUMBP r rF MS SIJLD 2
CHANGE 00 CHANGE
10/15/09
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/15/0' S
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MARSH CAFE
2.140 E. 116TH STREET
CARMEL, IN 46032
MARSH CA MARSH CAFE (317)575 -3650
2140 E. 116TH STREET 2140 E. 116TFl STREET 5991 DEANS SKIM [CHUG PC I OS F
CARMEL, IN 46032 CARMEL, IN 46032 977 UASANT 20Z 1.`19 f
(317)575 -3650 (317)575 -3650 0.50 lb L 2 99 /lb MAN Wl
WT 3283 APPI_f -S HONEYCRI:SP I.'.,r:; f=
486 20 OZ DRINK 1.09 SALAD BA!{
�1 6 B Z00 UNUSEII f'1iAP.hIRC'i Flt' ()1
486 20 OZ DRINK 1.Q`.? 1.99 80Z 50UP 1 9`., 1 950 ESPRssf )"CAPPCIN(I G.nn 1
tr TAX 19 13 f 3 SALAD BAR 4 21 1 950 ESPRSS0/ APf'CIr10
1 .99 80Z SOUP -9 F TAX .56 BAI_ E. =11
TAX EXEMPTION SALAD BAR n
2.69 1602 SOUP TAX EXhhll'TIUN 36
xx TAX .00 8AL .I IS SALAD BAR
5 TAX 00 Bail_ 6 05
TAX 00 BAI_ 1i1 637fi SNAP L) I ICE Trn 00
1.49 80Z SU11P t TAX 00 BAL
r: TAX 2 ()8 GAI_
SUPERMARKF7 II11
116TH STREET TAX !XEh1PTI0fJ MARSH SLIPLRr1ARkEf h19
iN 96032 2190 E. 11616 TREEI
17 t5 3550 x2.frx TAX 00 ;A( 5, 3,5 CARMEL, IN 46032
1317)575
PURCHASE TRX i
00 kn1-
EF I PuRC 10i 15109 10 HM
ITH: 015658-------
RSH SUFERMARKET pl4 AUTH:0158013
YMENT AMOUNT 2 18 90 E. 116TH STREEI
PAYMENT AMOUII K
'RME!., IN 46032
1 715 5 -3f;50
CHANGE (JO T PURCHASL I0,i1!) rim OF CREDIT
Rp CHANGE
IAL NUMBED TTFFt:> SOLLI ITH:01579B 10 [A(-- NUr1GER OF 1.TEf1S SOLO r,
{109 2 �vMENT A
MOUND
153
CREDIT__ ,j
5J
CHANGE i,7
1TAL NUM
/15l09 r
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
10/26/09 CITY OF CARMEL
An invoice or 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
Nancy Heck Purchase Order No.
One Civic Sq Terms
Carmel IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/15/C9 Receipt Lunch for Connecting w Carmel film crew $63.71
Total $63.71
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.
10/26109
ALLOWED 20
Nancy Heck IN SUM OF
One Civic Sq
Carmel In 46032
63.71
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayor 4355100
Promo f
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Receip 4355100 $63.71 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
/d 20o
i Sign ure
�tn Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
LOCKER REFUND RECEIPT
Receipt 343727 1 IE n W 1
Payment Date: 1 011 2/20 09
Household 10954 Q 2009
Home Phone: (317)431 -5393
NANCY HECK Monon Center
1326 COOL CREEK DR. Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Locker Registration Details:
CANCELLATION Refund Of 24.23
Member Name: Nancy Heck Fees Tax Discount Prev Paid Cur Paid Amount Due
Locker Room: Fitness Center Women 20.77 0.00 20.77 0.00 0.00
Locker Number: 109
Valid Dates: 09/01/09 to 11/30/09
Fee Details. Fee Description Amoun Count Discount Sales Tax Total Fee
Admin fee 20.77 1.00 0.00 0.00 20.77
Cancel Reason: no longer have MC pass
CANCELLATION Refund Of 24.23
Member Name: Richard Heck Fees Tax Discount Prev Paid Cur Paid Amount Due
Locker Room: Fitness Center Mens 20.77 0.00 20.77 0.00 0.00
Locker Number: 78
Valid Dates: 09/01/09 to 11 /30/09
Fee Details: Fee Description Amount Count Discount Safes Tax Total Fee
Admin fee 20.77 1.00 0.00 0.00 20.77
Cancel Reason: no longer have MC pass
G/L Code Des cription Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 48.46 DR
The REVENUE account was DEBITED and the CONTROL account was CREDITED on the day of the refund.
Finance will have to DEBIT the CONTROL account for the amounts listed above after the checks have been written to the customers.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10/12/09 09:28:47 by CEK FEES CHANGED ON CANCELLED ITEMS 48.46
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NETeAMOUNTtiFROM CANCELLED`ITEMS s ,'48:46
.TOTAL'AMOUNT:REFUNDED_ ":y,,?,
Page 1
LOCKER REFUND RECEIPT
Receipt 343727
Payment Date: 10/12/2009
Household 10954
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 48.46 Made By REFUND FINAN With Reference locker cancellation
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No cash or credit card refunds.
Authorized Signature Date Authorized Signature Date
L(U) ��L) q 35� V Uu'
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.
Heck, Nancy Terms
1326 Cool Creek Dr. Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/12/09 343727 Refund 48.46
Total 48.46
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.
Heck, Nancy Allowed 20
1326 Cool Creek Dr.
Carmel, IN 46032
In Sum of
48.46
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1047 343727 4358400 48.46 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
22 -Oct 2009
Signature
48.46 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund