HomeMy WebLinkAbout208357 04/25/2012 CITY OF CARMEL, INDIANA VENDOR: 366177 Page 1 of 1
ONE CIVIC SQUARE JUSTIN KEMPF
CARMEL, INDIANA 46032 10220 N DELAWARE ST CHECK AMOUNT: $35.00
INDIANAPOLIS IN 46280 CHECK NUMBER: 208357
CHECK DATE: 4/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 35.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 809826
'o,"Te c 0Y Payment Date: 04/10/12
Household 38690
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Monon Community Center Justin Kempf Hm Ph: (317)879 -2400
Carmel IN 46032 APR 13 2012 10220 North Delaware St
Indianapolis IN 46280 Cell Ph: (317)256-4866
jkempf @rshughes.com
Phone: (317)848 -7275 BY
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 35.00
Pass Holder: Justin Kempf Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Adlt Mthly (M MCAM), #124800 0.00 0.00 0.00 0.00 0.00
Valid Dates: 06/22/2011 to 12/14/2012 (Pass Cancellation)
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 04/10/12 14:58:15 by JCB FEES ADJUSTED ON CHANGED ITEMS 35.00
NET °AMOUNT FROM CHANGED ITEMS 35.00-
TOTAL AMOUNT REFUNDED 35.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 35.00 Made By REFUND FINAN With Reference Staff Error
All refunds are subject to State Board of Accounts claim procedure and 4 -6 ee process. A check will be
issued. No cash or credit card refunds.
Z' 41111
Au orized Signature D to Au or ed Signa r at
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: /2011cpry .theregistrationsystem.com /en /1033!
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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.
Kempf, Justin Terms
10220 North Delaware St Date Due
Indianapolis, IN 46280
Invoice a809826 Description
Date (or ;not;eattached invoice(s) or bill(s)) Amount
4/10/12 TR e fund 35.00
Total 35.00
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.
Kempf, Justin Allowed 20
10220 North Delaware St
Indianapolis, IN 46280
In Sum of
35.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 809826 4358400 35.00 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
�Ids
19 -Apr 2012
i
P &JI �o 'Yli' y
Signature
35.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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