HomeMy WebLinkAbout204833 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 365878 Page 1 of 1
ONE CIVIC SQUARE JERRY HERALD
I'� CHECK AMOUNT: $76.00
10710 WESTFIELD BLVD
CARMEL, INDIANA 46032
INDIANAPOLIS IN 46280 CHECK NUMBER: 204833
on
CHECK DATE: 12/20/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 76.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 762326
16 Et' Payment Date: 12/15/11
a}` Household 9469
Parks& eCreat-ion
Carmel Clay Parks Recreation Jerry Herald Hm Ph: (317)846 -9246
1235 Central Park Drive East 10710 Westfield Blvd Wk Ph: (317)338 -9095
Carmel IN 46032 Indianapolis IN 46280 Cell Ph: (317)504-8595
jdherald01 @yahoo.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 76.00
Pass Holder: Jerry Herald Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MCorp HH Mty (M CPHHM), #151019 152.00 0.00 152.00 0.00 0.00
Valid Dates: 10/25/2011 to 03/08/2012 (Pass Change)
Special questions: Company: St. Vincent Health
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 12/15/11 14:11:49 by ABK FEES ADJUSTED ON CHANGED ITEMS 76.00
NET AMOUNT'FROM CHANGED ITEMS 76.00
TOTAL AMOUNT REFUNDED 76.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 76.00 Made By REFUND FINAN With Reference
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.
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Authorized igna re Date Authorized Signature Dale
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: /2011cpry .theregistrationsystem.com /en /1033!
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AL, 74-
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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.
Herald, Jerry Terms
10710 Westfield Blvd Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/15/11 762326 Refund 76.00
"Total 76.00
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.
Herald, Jerry Allowed 20
10710 Westfield Blvd
Indianapolis, IN 46280
In Sum of
76.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 762326 4358400 76.00 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
15 -Dec 2011
zdmLY
Signature
76.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund