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Home My WebLink About205637 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 365952 Page 1 of 1 ONE CIVIC SQUARE LARRY WILSON CHECK AMOUNT: $197.00 a`. CARMEL, INDIANA 46032 9626 CYPRESS WAY CARMEL IN 46032 CHECK NUMBER: 205637 CHECK DATE: 1/17/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4358400 197.00 REFUNDS AWARDS INDE PASS REFUND RECEIPT Receipt 771189 Carmel *Clay Payment Date: 01/10/12 Darks &Recreation o 19 0 T R W R Household 36612 JAN 1 1 2012 0 Monon Community Center Larry Wilson Hm Ph: (317)757 -5123 Carmel IN 46032 9626 Cypress Way k Ph: (317)554-3166 BY: Carmel IN y 46032 Cell Ph: (317)506-7787 jwinbun@dakichlaw.com Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Pass Details Pass Holder: Colin Wilson Fees Tax Discount Prey Paid Cur Paid Amount Due Pass Type: Sep Month PM (ESEMSP), #157236 211.00 0.00 0.00 211.00 0.00 Valid Dates: 09/06/2011 to 09/30/2011 (New Pass Registration) Pass Holder: Colin Wilson Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Oct Month PM (ESEMOP), #157237 255.00 0.00 0.00 255.00 0.00 Valid Dates: 10/03/2011 to 11/04/2011 (New Pass Registration) Pass Holder: Colin Wilson Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Nov Month PM (ESEMNP), #157238 200.00 0.00 0.00 200.00 0.00 Valid Dates: 11/07/2011 to 12/02/2011 (New Pass Registration) Pass Holder: Colin Wilson Fees Tax Discount Prey Paid Cur Paid Amount Due Pass Type: Dec Month PM (ESEMDP), #157239 100.00 0.00 0.00 100.00 0.00 Valid Dates: 12/05/2011 to 12/15/2011 (New Pass Registration) Pass Holder: Colin Wilson Fees +Tax Discount Prev Paid Cur Paid Amount Due Pass Type: 1 -3 Week 20 PM (ESE1320P), #157240 38.00 0.00 0.00 38.00 0.00 Valid Dates: 01/03/2012 to 01/06/2012 (New Pass Registration) Pass Holder: Colin Wilson Fees +Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Aug Month PM (ESEMAP), #157235 211.00 0.00 0.00 211.00 0.00 Valid Dates: 08/09/2011 to 09/02/2011 (Pass Transfer from Flat Year PM) PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 01/10/12 10:08:09 by JAB FEES ADJUSTED ON CHANGED ITEMS 197.00 NET AMOUNT FROM CHANGED ITEMS 197.00 7 TOTAL AMOUNT REFUNDED 197.00 NEW NET HOUSEHOLD BALANCE 0.00 Refund of 197.00 Made By REFUND FINAN With Reference check refund Payment of 1,015.00 Made By Pass Management Credit Balance All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be i No cash or credit card refunds. IU. IZ 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. Wilson, Larry Terms 9626 Cypress Way Date Due Carmel, IN 46032 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 1/10/12 771189 Refund 197.00 Total 197.00 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. Wilson, Larry Allowed 20 9626 Cypress Way Carmel, IN 46032 In Sum of 197.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1081 -09 771189 4358400 197.00 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 PA&MuraA- Signature 197.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund