207600 03/26/2012 CITY OF CARMEL, INDIANA VENDOR: 366117 Page 1 of 1
ONE CIVIC SQUARE BEV ROSENBLUM
CARMEL, INDIANA 46032 9920 CHINQUAPIN COURT CHECK AMOUNT: $28.00
CARMEL IN 46033
CHECK NUMBER: 207600
CHECK DATE: 3/26/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 28.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 803406
C ar Mel o Clay Payment Date: 03/21/12
Household 19441
Parks& Recreation
Monon Community Center �01� Bev Rosenblum Hm Ph: (317)573 -0077
Carmel IN 46032 MAP` 9920 Chinquapin Ct. Wk Ph: (317)844 -2696
Carmel IN 46033 Cell Ph: (317)523-5379
Phone: (317)848 -7275 BY:
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 28.00
Pass Holder: Bev Rosenblum Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: FIT Adlt Mnthly (XM FTAM), #112335 0.00 0.00 0.00 0.00 0.00
Valid Dates: 01/15/2012 to 01/14/2013 (Pass Cancellation)
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 03/21/12 13:40:30 by KLB FEES ADJUSTED ON CHANGED ITEMS 28.00-
0
NET�AMOUNT,FROM:,CHANGED ITEMS.i:z;,,' 28.00=
TOTAL AMOUNT REFUNDED', 28.00`
NEW NET HOUSEHOLD BALANCE 0.00
g .��C� 1n r
Refund of 28.00 Made By REFUND FINAN With Reference cancelled in; February
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.
3 2.I 12
Authorized Signature Date AutW7T ature bate
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:H201 lcpry .theregistrationsystem.com /en /1033!
092. LA35ay00
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.
Rosenblum, Bev Terms
9920 Chinquapin Ct. Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/21/12 803406 Refund 28.00
Total 28.00
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.
Rosenblum, Bev Allowed 20
9920 Chinquapin Ct.
Carmel, IN 46033
In Sum of
28.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 803406 4358400 28.00 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
22 -Mar 2012
Signature
28.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund