176858 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 363291 Page 1 of 1
ONE CIVIC SQUARE TIFFANY MONTGOMERY CHECK AMOUNT: $85.00
CARMEL, INDIANA 46032 10434 FERGUS AVE
CARMEL IN 46032 CHECK NUMBER: 176858
CHECK DATE: 912/2009
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUM AMOUNT DESCRIPTION
1046 4358400 85.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 329642 qq
Payment Date: 08/20/2009 I;
Household 20983
Home Phone: (317)250 -2519 AU6 2 0 2009
Work Phone:
TIFFANY MONTGOMERY Monon Center
10434 FERGUS AVE. Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Oria Bal Refund New Bal
Module: Pass Management 85.00- 85.00 0.00
G/L Code_ Description Account Number Cst_Cntr__ Description_ Account_ Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 85.00 DR
Finance will have to DEBIT the CONTROL account for the amounts listed above after the checks have been written to the customers.
PREVIOUS NET HOUSEHOLD BALANCE 85.00
Processed on 08/20/09 08:34:41 by JAS NEW REFUND AMOUNT 85.00
V t'. Vl k ik V1 6 I TOTAL REFUNDABLE AMOUNT 85.00
NEW NET HOUSEHOLD BALANCE 0.00
4 OA
Refund of 85.00 Made By REFUND FIN N With Reference check refund
All refunds apoubject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued! No a or cred't card r unds.
0� �0
A h ize ignat Date Authorized Signature Date
Page 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.
Montgomery, Tiffany Terms
10434 Fergus Ave Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/20/09 329642 Refund 85.00
Total 1 85.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Montgomery, Tiffany Allowed 20
10434 Fergus Ave
Carmel, IN 46032
In Sum of
y
85.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members
Dept
1046 329642 4358400 85.00 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
27 -Aug 2009
Signature
85.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund