HomeMy WebLinkAbout201481 09/13/2011 CITY OF CARMEL, INDIANA VENDOR: 365656 Page 1 of 1
ONE CIVIC SQUARE LI ZHAO
CHECK AMOUNT: $37.50
CARMEL, INDIANA 46032 13438 SALAMONE WAY
w o WESTFIELD IN 46074 CHECK NUMBER: 201481
CHECK DATE: 9/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 37.50 PARKS DEPARTMENT REFU
LOCKER REFUND RECEIPT
Receipt 721181
Payment Date: 08/29/11
Household 10269
a
Monon Community Center I S E P 0 1 201 1 h Li Zhao Hm Ph: (603)686 -7431
Carmel IN 46032 13438 Salamone Way Wk Ph: (317)
Westfield IN 46074 Cell Ph: (952)221-3031
Phone: (317)848 -7275 n kakevin_693 @hotmail.com
Fed Tax ID #35- 6000972
Locker Registration Details:
CANCELLATION Refund Of 37.50
Member Name: Li Zhao Fees Tax Discount Prev Paid Cur Paid Amount Due
Locker Room: Fitness Center Women 112.50 0.00 0.00 112.50 0.00
Locker Number 91
Valid Dates: 11101110 to 11/01/11
Cancel Reason: Cancelled membership on 8/28/11 due to moving out of state.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/29/11 16:01:08 by LWW FEES CHANGED ON CANCELLED ITEMS 150.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 112.50
NETAMOUNT "F.ROM'CANCELLED"1TEM5 37150
w —1
14 J TOTAL AMOUNT REFUNDED 37750 VA4yj�� NEW NET HOUSEHOLD BALANCE 0.00
Refund of 37.50 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.
Authori d 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 ($10 for same dayday -of registration). Pre register online at www.carmelclayparks.com
or pick up a form at the Monon Community Center. All participants will receive a goodie bag and a T -shirt if registered on or
before August 26.
The Adaptive 10 -mile Ride is for individuals with special needs only. Individuals will ride as a group on the 10 -mile route. Staff
will be staggered within the group throughout the ride. Group will meet at the Monon Community Center in the designated tent
at the start line for check -in at 8:00 a.m. Group will begin the ride at 8 :30 a.m. sharp.
`ocico, 2[, 435�400
Page 1
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Zhao, Li Terms
13438 Salamone Way Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/29/11 721181 Refund 37.50
Total 37.50
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10-1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
Zhao, Li Allowed 20
13438 Salamone Way
Westfield, IN 46074
In Sum of$
37.50
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -21 721181 4358400 37.50 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
37.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund