205723 01/31/2012 *f CITY OF CARMEL, INDIANA VENDOR: 365966 Page 1 of 1
ONE CIVIC SQUARE TERESA MYERS CHECK AMOUNT: $26.00
CARMEL, INDIANA 46032 726 W MAIN ST
CARMEL IN 46032 CHECK NUMBER: 205723
CHECK DATE: 1/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 26.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 778865
Carmel el Clay Payment Date: 01/25/12
„j
Parks &Recreation Household 20954
Carmel Elementary Teresa Myers Hm Ph: (317)846 -8006
101 4th Avenue SE 726 W Main St. Wk Ph: (317)212 -6385
Carmel IN 46033 Carmel IN 46032 Cell Ph: (317)443 -0302
telmac2@aol.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
Pass Holder: Berl Myers Fees Tax Discount Prey Paid Cur Paid Amount Due
Pass Type: Sep Month PM (ESEMSP), #158448 211.00 0.00 0.00 211.00 0.00
Valid Dates: 09/06/2011 to 09/30/2011 (New Pass Registration)
Pass Holder: Ben Myers Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Oct Month PM (ESEMOP), #158449 255.00 0.00 0.00 255.00 0.00
Valid Dates: 10/03/2011 to 11/04/2011 (New Pass Registration)
Pass Holder: Ben Myers Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Nov Month PM (ESEMNP), #158450 200.00 0.00 0.00 200.00 0.00
Valid Dates: 11/07/2011 to 12/02/2011 (New Pass Registration)
Pass Holder: Ben Myers Fees Tax Discount Prey Paid Cur Paid Amount Due
Pass Type: Dec Month PM (ESEMDP), #158451 100.00 0.00 0.00 100.00 0.00
Valid Dates: 12/05/2011 to 12/15/2011 (New Pass Registration)
Pass Holder: Ben Myers Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 4 -5 Week 20 PM (ESE4520P), #158452 57.00 0.00 0.00 57.00 0.00
Valid Dates: 01/03/2012 to 01/06/2012 (New Pass Registration)
Pass Holder: Ben Myers Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 1 -3 Week 21 PM (ESE1321 P), #158453 38.00 0.00 0.00 38.00 0.00
Valid Dates: 01/09/2012 to 01/13/2012 (New Pass Registration)
Pass Holder: Ben Myers Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 1 -3 Week 22 PM (ESE1322P), #158454 38.00 0.00 0.00 38.00 0.00
Valid Dates: 01/17/2012 to 01/20/2012 (New Pass Registration)
Pass Holder: Ben Myers Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 1 -3 Week 23 PM (ESE1323P), #158455 38.00 0.00 0.00 38.00 0.00
Valid Dates: 01/23/2012 to 01/27/2012 (New Pass Registration)
Pass Holder: Ben Myers Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 1 -3 Week 24 PM (ESE1324P), #158457 38.00 0.00 0.00 38.00 0.00
Valid Dates: 01/30/2012 to 02/03/2012 (New Pass Registration)
Pass Holder: Ben Myers Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Aug Month PM (ESEMAP), #158447 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)
Page 1 of 2
PASS REFUND RECEIPT
��m�l�J Receipt# 778865
Darks &Recreation Payment Date: 01/25/2012
Household 20954
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 01/25/12 10:22:01 by SLH FEES ADJUSTED ON CHANGED ITEMS 26.00
NET AMOUNT FROM CHANGED ITEMS 26.00
Xv l XU (J (J TOTAL AMOUNT REFUNDED 26.00
p
VV k� NEW NET HOUSEHOLD BALANCE 0.00
Refund of 26.00 Made By �=SRE(UND FINAN With Reference
y t of 1,186.00 Made B Pass Management Credit Balance
All refun are sub' t to State Board of A Pt�C`aim procedure and may take 4 -6 weeks to process. A check will be
is ue cash r cr dit card refunds.
a 1 -2, �Z
Authori d 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:H2011 cprv. theregistrationsystem .com /en /l 033!
JAN 2 6 2012
BY:
Page 2 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.
Myers, Teresa Terms
726 W main St Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/25/12 778865 Refund 26.00
Total 26.00
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.
Myers, Teresa Allowed 20
726 W main St
Carmel, IN 46032
In Sum of
26.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -1 778865 4358400 26.00 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
26 -Jan 2012
Signature
26.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund