HomeMy WebLinkAbout209611 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 00350952 Page 1 of 1
ONE CIVIC SQUARE MARY CHURCHILL
CARMEL, INDIANA 46032 10902 WILLOMERE DRIVE CHECK AMOUNT: $105.00
't o INDIANAPOLIS IN 46280 CHECK NUMBER: 209611
CHECK DATE: 6/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 105.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 837086
C� it h ml b l 0 C lo y Payment Date: 05/30/12
Household 12092
Pa
rks1A&.eation
Monon Community Center Mary Churchill Hm Ph: (317)843 -1322
Carmel IN 46032 JUN 2012 10902 Willomere Dr Wk Ph: (800)421 -0180
Indianapolis IN 46280 Ext. 33312
Cell Ph: (317)453-1137
Phone: (317)848 7275'
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 105.00
Pass Holder: Brandon Churchill Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Adlt Mthly (M MCAM), #152387 140.00 0.00 0.00 140.00 0.00
Valid Dates: 11/08/2011 to 11/08/2012 (Pass Cancellation)
Cancellation Effective: 05/30/2012
Cancel Reason: had two open accounts /refund per KLB
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 05/30/12 14:57:48 by MJN FEES CHANGED ON CANCELLED ITEMS 245.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 140.00
NET AMOUNT FROM CANCELLED. ITEMS' 105;00
TOTAL:AMOUNTREF.UNDED 105 0KE
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 105.00 Made By REFUND FINAN With Reference staff error
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 refund p.
Authorize Si ature Date uthor e 44 6re ate
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: /2011cprv. theregistrationsystem .com /en/1033!
DAY PASSES ARE NON REFUNDABLE
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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.
Terms
Churchill, Mary Date Due
10902 Willomere Dr
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/30/12 837086 Refund 105.00
Total 105.00
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.
Allowed 20
Churchill, Mary
10902 Willomere Dr
Indianapolis, IN 46280 In Sum of
105.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 837086 4358400 105.00 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
1 -Jun 2012
s iZQC� -r1 rr161-7
Signature
105.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund