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