209272 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 366253 Page 1 of 1
ONE CIVIC SQUARE UMA NAGARAJA
CARMEL, INDIANA 46032 CHECK AMOUNT: $104.00
r• 12792 TRUMAN COURT
CARMEL IN 46032 CHECK NUMBER: 209272
CHECK DATE: 5/22/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 104.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 827376
Carmel 0 Clay! Payment Date: 05/16/12
JJ Household 31111
Parks Re. creation
Monon Community Center Uma Nagaraja Hm Ph: (317)663 -3223
Carmel IN 46032 a— nnig Wk Ph: (317)
G( _Was#i Cell Ph: (812)230 -6500
Phone: (317)848-7275 umanagaraja @yahoo.com
I+J
Fed Tax ID #35- 6000972 C��' y o3d
Pass Details
CANCELLATION Refund Of 104.00
Pass Holder: Neha Nagaraja Fees Tax Discount Prey Paid Cur Paid Amount Due
Pass Type: 10 -Visit (ESE10V), #83342 26.00 0.00 26.00 0.00 0.00
Valid Dates: 08/11/2009 to 05/27/2012 (Pass Cancellation)
Cancellation Effective: 05/16/2012
cancel Reason: o longer need ese
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 05/16/12 12:26:16 by BJJ FEES CHANGED ON CANCELLED ITEMS 104.00
NET AMOUNT FROM CANCELLED ITEMS 104,00-
I TOTAL AMOUNT REFUNDED 104.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 104.00 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. 7cash or credit card refunds.
Aut ized Signature Date Authorized Signature Date
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!
DAY PASSES ARE NON REFUNDABLE
I ITIC .:tea
1 MAY 1 2012
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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.
Nagaraja, Uma Terms
12792 Truman Ct Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/16/12 827376 Refund 104.00
Total 104.00
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.
Nagaraja, Uma Allowed 20
12792 Truman Ct
Carmel, IN 46032
In Sum of
104.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -10 827376 4358400 104.00 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
17 -May 2012
signature
104.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund