205637 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