HomeMy WebLinkAbout204226 12/06/2011 CITY OF CARMEL, INDIANA VENDOR: 365829 Page 1 of 1
t' ONE CIVIC SQUARE TOM FULLER
CARMEL, INDIANA 46032 10181NDIANPIPE CIRCLE CHECK AMOUNT: $120.00
CARMEL IN 46033
CHECK NUMBER: 204226
CHECK DATE: 12/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 120.00 PARKS DEPARTMENT REFU
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PASS REFUND RECEIPT
Receipt 752049
i 'I 9 la Payment Date: 11/17/11
Household 33025
rk &Recr atiori
Monon Community Center t�'P �i`` Tom Fuller Hm Ph: (317)571 -9264
Carmel IN 46032 I 1018 Indianpipe Circle
4t NOV 18 20i Carmel IN 46033 Cell Ph: (317)753 -1540
fullerwezzie @hotmail.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
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Pass Details
MEMBERSHIP CHANGE Refund Of 120.00
Pass Holder: Tom Fuller Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: PT1 5x30 min (M PT1530), #124263 30.00 0.00 30.00 0.00 0.00
Valid Dates: 12/07/2010 to 03/07/2012 (Pass Change)
Pass Visit Info: Number of Visits: 4
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 11/17/11 14:29:06 by LWW FEES ADJUSTED ON CHANGED ITEMS 120.00-
0 V 1 0. NET AMOUNT FROM "CHANGED ITEMS 120:00=`
�Y1 I �0'
TOTAL'AMOUNT'REFUNDED 7 120:00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 120.00 Made By REFUND FINAN With Reference Check refund
All refunds are subject to State Board of Accounts claim procedure and may to weeks to process. A check will be
issued. No cash or credit card refunds.
bW 11.1(0.11 0 1-7/h
Authorized Signature Date A ize ign ture D to
Volunteer with Us!
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 .H2011cpry .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.
Fuller, Tom Terms
1018 Indianpipe Circle Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/17/11 752049 Refund 120.00
Total 120.00
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.
Fuller, Tom Allowed 20
1018 Indianpipe Circle
Carmel, IN 46033
In Sum of
120.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -22 752049 4358400 120.00 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
1 -Dec 2011
Signature
120.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund