HomeMy WebLinkAbout200802 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 365631 Page 1 of 1
ONE CIVIC SQUARE MARIANN BURNSIDE
CARMEL, INDIANA 46032 13510 SHAKAMAN DRIVE CHECK AMOUNT: $70.00
CARMEL IN 46032 CHECK NUMBER: 200802
CHECK DATE: 8/30/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 70.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 0 687142
Payment Date 07122111
Household 10132
Monon Community Center Mariann Burnside Hm Ph: (317)815 -8777
Carmel IN 46032 13510 Shakamac Drive
Carmel IN 46032 Cell Ph:
them side@indy. rr.com
Phone: (317)84 &7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 70.00
Pass Hoider. Tom Burnside F Mar= _Prev Paid Cur Pain &WUnt pua
9^ A �3` "tE$` i (tij'; MCAM), #125724 175.00 0.00 0.00 175.00 0.00
daiid vales: 12129/2010 to- 12129 Pass Cancellation)
Cannel Reason: not using
NET AMOUNT FROM CANCELLED MEMS
i L�� i TOTAL AMOUNT REFUNDED
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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.
Burnside, Mariann Terms
13510 Shakamac Drive Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7122111 687142 Refund 70.00
Total 70.00
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.
Burnside, Mariann Allowed 20
13510 Shakamac Drive
Carmel, IN 46032
In Sum of
70.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1092 687142 4358400 70.00 1 hereby certify that the attached invoice(s), or
bitl(s) is (are) true and correct and that the
mz:terials or services itemized thereon for
which charge is made were ordered and
received except
26 -Aug 2011
Signature
70.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund