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Home My WebLink About205714 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