HomeMy WebLinkAbout201200 09/13/2011 CITY OF CARMEL, INDIANA VENDOR: 365650 Page 1 of 1
ONE CIVIC SQUARE HOWARD ETHERINGTON
s,. r CARMEL, INDIANA 46032 123 SHERMAN DRIVE CHECK AMOUNT: $90.00
CARMEL IN 46032
CHECK NUMBER: 201200
CHECK DATE: 9/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 90.00 REFUND
PASS REFUND RECEIPT
Receipt 721072
Payment Date: 08/29/11
Household 23652
Monon Community Center Howard Etherington Hm Ph: (317)844 -1409
Carmel IN 46032 123 Sherman Dr.
Carmel IN 46032 Cell Ph: (317)403 -5336
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 90.00
Pass Holder: Beth Etherington Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: PT1 5x30 min (M PT1530), 9106461 60.00 0.00 60.00 0.00 0.00
Valid bates: 03/31/2011 to 06/30/2012 Pass Change)
Pass Visit Info: Number Of Visits: 3
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 0812911�1 10:�5 by LWW y FEES ADJUSTED ON CHANGED ITEMS 90.00-
NET,AM0UNT FROWCHANGED1TEMS 90.00
"T0TAL'AM0l1NT,'REFU NDED 90.00:
�7 NEW NET HOUSEHOLD BALANCE 0.00
Refund of 90.00 Made By REFUND FINAN With Reference Check refund
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.
UAl'i aj&�J
Authorized Signature Date Authorized Signature Date
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.
AEG 3 1 2011
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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.
Etherington, Howard Terms
123 Sherman Dr. Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8129111 721072 Refund 90.00
'Total 90.00
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
1 20
Clerk Treasurer
Voucher No. Warrant No.
Etherington, Howard Allowed 20
123 Sherman Dr.
Carmel, IN 46032
In Sum of
90.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1096 -22 721072 4358400 90.00 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
9 -Sep 2011
Signature
90.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I