205714 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 365962 Page 1 of 1
ONE CIVIC SQUARE JOSEPHINE BROADNAX CHECK AMOUNT: $235.00
CARMEL, INDIANA 46032 3574 CORSHAM CIRCLE
_•;.cF CARMEL IN 46032 CHECK NUMBER: 205714
CHECK DATE: 1131/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 235.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 778629
Cannel I& Clay Payment Date: 01/24/12
ParksAccreatlon Household 106
Monon Community Center Josephine Broadnax Hm Ph: (317)733 -0343
Carmel IN 46032 3574 Corsham Circle Wk Ph: (317)276 -0325
Carmel IN 46032 Cell Ph: (317)
Jbroadnax@indy.rr.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 235.00
Pass Holder: Carmen Broadnax Fees Tax Discount Prey Paid Cur Paid Amount Due
Pass Type: Jan Month PM (ESEMJP), #157985 0.00 0.00 0.00 0.00 0.00
Valid Dates: 01/03/2012 to 02/03/2012 (Pass Cancellation)
PREVIOUS NET HOUSEHOLD BALANCE 20.00
Processed on 01/24/12 11:31:09 by JAB FEES CHANGED ON CANCELLED ITEMS 255.00
1 NET AMOUNT FROM CANCELLED ITEMS 255.00
HH BALANCE APPLIED TO THIS RECEIPT 20.00
TOTAL AMOUNT REFUNDED 235.00
t)IEW NET HOUSEHOLD BALANCE 0.00
Refund of 235.00 Made By REFUND FINAN With Reference check refund
refun are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
§sued. N cash or credit card refunds. l
1 L f I
Author ze Signature Date Authorized Signature Date
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 cprv. theregistrationsystem .com /en /l 033!
J AN 2 4 2012
BY:
Page 1 of 1
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.
Broadnax, Josephine Terms
3574 Corsham Circle Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)) Amount
1/24/12 778629 Refund 235.00
Total 235.00
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
Broadnax, Josephine Allowed 20
3574 Corsham Circle
Carmel, IN 46032
In Sum of
235.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -9 778629 4358400 235.00 1 hereby certify that the attached invoice(s), or
bi;l(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
26 -Jan 2012
Signature
235.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund