200943 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 365635 Page 1 of 1
ONE CIVIC SQUARE SUSAN MCINTOSH
CARMEL, INDIANA 46032 2891 VININGS DRIVE CHECK AMOUNT: $28.00
CARMEL IN 46032
<.o. CHECK NUMBER: 200943
CHECK DATE: 8/30/2011
DEPARTMENT A CCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 28.00 REFUND
PASS REFUND RECEIPT
Receipt 710139
Payment Date: 08/12/11
Household 32463
Monon Community Center Susan McIntosh Hm Ph: (317)846 -8459
Carmel IN 46032 2891 Vinings Dr
Carmel IN 46032 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 28.00
Pass Holder: Susan McIntosh Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: FIT Adlt Mnthly (XM FTAM), #92442 440.00 0.00 440.00 0.00 0.00
Valid Dates: 12/29/2009 to 01/14/2012 Pass Cancellation)
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/12/11 08:59:32 by TDJ FEES ADJUSTED ON CHANGED ITEMS 28.00
C j 1 r� D NET AMOUNT FROM CHANGED ITEMS 28.00
p l U 7` I TOTAL AMOUNT REFUNDED 28.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 28.00 Made By REFUND FINAN With Reference cancelled earlierTDJ
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.
Auto4ed&64 D e ut -'ed S' nature D Tte
Join us for St. Vincent Tour de Carmel, a bike ride along 10 -mile and 20 -mile routes through the city of Carmel. Rest stops will
have a variety of healthy snacks, drinks and entertainment. After the ride, the finish line will offer more entertainment and
refreshments. The cost is $8 per rider ($10 for same dayday -of registration). Pre register online at www.carmelclayparks.com
or pick up a form at the Monon Community Center. All participants will receive a goodie bag and a T -shirt if registered on or
before August 26.
The Adaptive 10 -mile Ride is for individuals with special needs only. Individuals will ride as a group on the 10 -mile route. Staff
will be staggered within the group throughout the ride. Group will meet at the Monon Community Center in the designated tent
at the start line for check -in at 8:00 a.m. Group will begin the ride at 8:30 a.m. sharp.
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.
McIntosh, Susan Terms
2891 Vinings Dr Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8112111 710139 Refund 28.00
Total 28.00
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.
McIntosh, Susan Allowed 20
2891 Vinings Dr
Carmel, IN 46032
In Sum of
28.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members
Dept
1092 710139 4358400 28.00 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
26 -Aug 2011
Signature
28.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund