205437 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 365950 Page 1 of 1
ONE CIVIC SQUARE MARISOL DAVALOS CHECK AMOUNT: $42.00
CARMEL, INDIANA 46032 5681 TRAMMEL STREET
9�TOM GOr CARMEL IN 46033 CHECK NUMBER: 205437
CHECK DATE: 1/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 42.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 771242
Carmel e Clay Payment Date: 01/10/12
J Household 40007
Darks &Recreation 0 T C(� 3 9 W
JAN 1 1 2012
Monon Community Center Marisol Davalos
Carmel IN 46032 r Fetlock P
India a 46227 Ph: 317 490 -2069
mis P .......�.....1............
r risoIdavalos @ho com
Phone: (317)848 -7275 -��l;V VV f, t
Fed Tax ID #35- 6000972
Pass Details
Pass Holder: Monserrat Davalos Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Sep Month Both (ESEMSB), #157244 267.00 0.00 0.00 267.00 0.00
Valid Dates: 09/06/2011 to 09/30/2011 (New Pass Registration)
Pass Holder: Monserrat Davalos Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Oct Month Both (ESEMOB), #157245 324.00 0.00 0.00 324.00 0.00
Valid Dates: 10/03/2011 to 11/04/2011 (New Pass Registration)
Pass Holder: Monserrat Davalos Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Nov Month Both (ESEMNB), #157247 253.00 0.00 0.00 253.00 0.00
Valid Dates: 11/07/2011 to 12/02/2011 (New Pass Registration)
Pass Holder: Monserrat Davalos Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Dec Month Both (ESEMDB), #157248 127.00 0.00 0.00 127.00 0.00
Valid Dates: 12/05/2011 to 12/15/2011 (New Pass Registration)
Pass Holder: Monserrat Davalos Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Aug Month Both (ESEMAB), #157243 267.00 0.00 0.00 .267.00 0.00
Valid Dates: 08/09/2011 to 09/02/2011 (Pass Transfer from Flat Year Both)
PREVIOUS NET HOUSEHOLD BALANCE 256.00
Processed on 01/10/12 12:14:12 by JAB FEES ADJUSTED ON CHANGED ITEMS 42.00
NET AMOUNT FROM CHANGED ITEMS 42.00
D v v TOTAL AMOUNT REFUNDED 42.00
NEW NET HOUSEHOLD BALANCE 256.00
Refund of 42.00 Made By REFUND FINAN With Reference
Payment of 1,238.00 Made By Pass Management Credit Balance
efunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issue No cash or credit card refunds.
Authoriz d Signature Date Authorized Signature Date
�l
VV 0 A& -/Y M VW
77 J Page 1 of 2
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.
Davalos, Marisol Terms
5681 Trammel Street Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/10/12 771242 Refund 42.00
Total 42.00
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
Davalos, Marisol Allowed 20
5681 Trammel Street
Carmel, IN 46033
In Sum of
42.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -11 771242 4358400 42.00 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
12 -Jan 2012
Signature
42.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund