HomeMy WebLinkAbout204754 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 365875 Page 1 of 1
ONE CIVIC SQUARE TODD COOPER
CARMEL, INDIANA 46032 13505 DUNES DRIVE
CHECK AMOUNT: $25.50
CARMEL IN 46032 CHECK NUMBER: 204754
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CHECK DATE: 1212012011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 25.50 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 756704
Carmel Clay Payment Date: 12/07/11
rks &Recreation Household 31131
Monon Community Center Todd Cooper Hm Ph: (317)582 -0328
Carmel IN 46032 13505 Dunes Drive
Carmel IN 46032 Cell Ph: (317)979 -8385
toddandkristi hotmail.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 25.50
Pass Holder: Todd Cooper Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: KZ 50 Visit (M Z50), #65326 49.50 0.00 49.50 0.00 0.00
Valid Dates: 04/17/2010 to 07/17/2011 (Pass Cancellation)
Cancel Reason: prorated request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 12/07/11 Cam? 10:06:27 by LVA FEES CHANGED ON CANCELLED ITEMS 25.50
NET AMOUNT FROM CANCELLED ITEMS 25.50-
TOTAL AMOUNT REFUNDED 25.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 25.50 Made By REFUND FINAN With Reference prorated request
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.
1
l 12-1711
Authorizetur e Date Aut ed Sig ture Daft
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: //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.
Cooper, Todd Terms
13505 Dunes Drive Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number
or note attached invoice(s) or bill(s)) Amount
1217111 756704 Refund 25.50
Total 25.50
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.
Cooper, Todd Allowed 20
13505 Dunes Drive
Carmel, IN 46032
In Sum of$
25.50
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -41 756704 4358400 25.50 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
15 -Dec 2011
Signature
25.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund