202988 10/25/2011 CITY OF CARMEL, INDIANA VENDOR: T359616 Page 1 of 1
ONE CIVIC SQUARE JULIE FOGELSON
CARMEL, INDIANA 46032 819 TIMBER MILL LANE CHECK AMOUNT: $450.00
INDIANAPOLIS IN 46260 CHECK NUMBER: 202988
CHECK DATE: 10/25/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 741780 450.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 741780
Payment Date: 10/18/11
Household 6348
Monon Community Center Julie Fogelson Hm Ph: (317)731 -7390
Carmel IN 46032 819 Timber Mill Ln
Indianapolis IN 46260 Cell Ph: (317)460 -2201
J
Phone: (317)848 -7275 AFOGELSON @YAHOO.COM
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 450.00
Pass Holder: Julie Fogelson Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: PT1 10x60 min (M PT1106), #147969 0.00 0.00 0.00 0.00 0.00
Valid Dates: 09/11/2011 to 12/11/2012 Pass Cancellation)
Pass visit Info: Number of Visits: 10
Cancel Reason: Illness (doctor's note provided)
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10/18/11 09:17:47 by LWW FEES CHANGED ON CANCELLED ITEMS 450.00
NET AMOUNT.FROM",CANCELLED ITEMS
450.00
0 D
TOTAL AMOUNT,REFUNDED 450:00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 450.00 Made By REFUND FINAN With Reference Check refund
All refunds are subject to State Board of Accounts claim procedure and may tak 6 weeks to process. A check will be
issued. No cash or credit card refunds.
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Authorized Signature Date A od ed Sign re at
Volunteer with Us! 1 G 22.
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Volunteers are the foundation of Carmel Clay Parks Recreation and we need your help! We are currently seeking volunteers
for special events, adaptive programs, parks and greenways, and Extended School Enrichment. If interested, please call Dana
at 317.843.3868 or register online at https: //2011 cpry .theregistrationsystem.com /en /1033!
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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.
Fogelson, Julie Terms
819 Timber Mill Ln Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/18/11 741780 Refund 450.00
Total 450.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Fogelson, Julie Allowed 20
819 Timber Mill Ln
Indianapolis, IN 46260
In Sum of
450.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -22 741780 4358400 450.00 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
20 -Oct 2011
`P�('.h� mjny)-�
Signature
450.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund