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HomeMy WebLinkAbout177696 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 363368 Page 1 of 1 ONE CIVIC SQUARE TERRY HITCHCOCK CARMEL, INDIANA 46032 7308 MARDYKE LANE CHECK AMOUNT: $171.79 INDIANAPOLIS IN 46226 CHECK NUMBER: 177696 CHECK DATE: 9/29/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1047 W 4358400 339310 171.79 REFUNDS AWARDS INDE 000339310 o @�ory &000!o Monon Center Clerk: RDG Date: 09/21/2009 Time: 06:33:34 H /H: Terry Hitchcock F /M: Terry Hitchcock Description Ext Price Pass 0 Type 103.21 Yly GF Res Unli From 05/07/2009 05/07/2010 Rcpt# 339310 Prev Bal: 0.00 New Charges 171.79 New Tax: 0.00 Total Due: 171.79 Tot Refund: 171.79 New Bal: 0.00 Refund Type: Refund from Finance REFUND FINAN Refund of: 171.79 All refunds are subject to State Board of Accounts claim procedure and may take r� 4 -6 weeks to process. A check will be issued. No cash or credit card refunds. S E N 2 2009 J m. Aut rized signature )ate Z/ J01 Authorized signature Date Fed Tax ID #35- 6000972 O I !f Rcpt# 339310 a@ Om Page 1 Staff Initials The I', Date: M olnon V Cent FDC Initials: 'I( 1;1 AT CEN TRAL P Date: Pass Cancellation Supervisory Date: Check Refun or Household Credit (Circle One) *Note: Check refunds take 3 4 weeks to process. Household credit will be placed on account for credit towards next transaction. If you are canceling a monthly passport you understand that you must give at least 7days prior notice to your next payment date. Name requesting cancellation: C CX-.• Phone Number: p Address: 13 /V 0 r- Ln city: E Q��1 r Zip: <99 Passholder Name(s): i Jc-�,cpcA t Pass that you would like to cancel: Pl. Today's Date(s): F F Reason for pass cancellation: d6 Ue Passholder's Signature: "Please turn into Front Desk Coordinator" Amount Approved: Refund or Credit on Date: Reason: 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. Hitchcock, Terry Terms 7308 Mardyke Lane Date Due Indianapolis, IN 46226 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 9/21/09 339310 Refund 171.79 Total 171.79 1 hereby certify that the attached invoice(s), or bills) 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. Hitchcock, Terry Allowed 20 7308 Mardyke Lane Indianapolis, IN 46226 In Sum of 171.79 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1047 339310 4358400 171.79 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 24 -Sep 2009 Signature 171.79 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund