HomeMy WebLinkAbout206969 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 366083 Page 1 of 1
ONE CIVIC SQUARE SHOLEH BIJANGI
CARMEL, INDIANA 46032 457 AUTUMN DRIVE CHECK AMOUNT: $146.73
CARMEL IN 46032
CHECK NUMBER: 206969
CHECK DATE: 3/1312012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 146.73 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 781370
a_r[hed O' Clay Payment Date: 02/02/12
J Household 409
Nrk R cl^e. ton
Monon Community Center Sholeh Bijangi Hm Ph: (317)843 -1294
Carmel IN 46032 457 Autumn Dr. Wk Ph: (317)278 -4874
Carmel IN 46032 Cell Ph:
sholehbijangi @yahoo.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 146.73
Pass Holder: Tirajeh Saadatzadeh Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: UnGrpFit Annual (M UGFA), #142544 153.27 0.00 153.27 0.00 0.00
Valid Dates: 07/30/2011 to 07/30/2012 (Pass Cancellation)
Cancel Reason: unable to fit class times into schedule
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 02/02/12 18:46:47 by MJN FEES CHANGED ON CANCELLED ITEMS 146.73
NET AMOUNT FROM CANCELLED ITEMS 146.73-
V ,7\ 6 TOTAL AMOUNT REFUNDED 146.73
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 146.73 Made By REFUND FINAN With Reference
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No cash or credit card refunds.
3z112-
Authorized Signature Date A t rized Vanature 6at
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/1033!
r,
J 2012
BY:
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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.
Bijangi, Sholeh Terms
457 Autumn Dr Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s))
Amount
2/2/12 781370 Refund 146.73
Total 146.73
I 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.
Bijangi, Sholeh Allowed 20
457 Autumn Dr
Carmel, IN 46032
In Sum of
146.73
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -22 781370 4358400 146.73 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
8 -Mar 2012
Signature
146.73 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund