HomeMy WebLinkAbout209833 06/18/2012 CITY OF CARMEL, INDIANA VENDOR: 366306 Page 1 of 1
ONE CIVIC SQUARE KELLEY ROBERTSON
CHECK AMOUNT: $45.00
CARMEL, INDIANA 46032 13613 STONE HAVEN DRIVE
't.roN,`Q i CARMEL IN 46033 CHECK NUMBER: 209833
CHECK DATE: 6/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 45.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 842903
flay Payment Date: 06
Household 4600 58
P rks &Recrea i on
Monon Community Center Kelley Robertson Hm Ph: (317)408 -5411
Carmel IN 46032 13613 Stone Haven Dr
Carmel IN 46033 Cell Ph: (317)417-3680
kelley.robertson @ymail.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 45.00
Pass Holder: Brooke Robertson Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type. 10 Visit (ESE10V), #165904 0.00 0.00 0.00 0.00 0.00
Valid Dates: 08/09/2011 to 05/24/2012 (Pass Cancellation)
Cancellation Effective: 06/08/2012
Cancel Reason: no longer need ese
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/08/12 11:52:45 by BJJ FEES CHANGED ON CANCELLED ITEMS 45.00
NET AMOUNT FROM CANCELLED ITEMS _45.00-
TOTAL;AMOUNT "REFUNDED 45.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 45.00 Made By REFUND FINAN With Reference 1081 -7- 4358400 0 ✓/v6
All refunds are subject to State Board of Accounts claim proc ay take 4 -6 weeks to process. A check will be
issued. N cash or credit card refunds.
A tize nature 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 cpry .theregistrationsystem.com /en /1033!
17")'T r T�
DAY PASSES ARE NON REFUNDABLE t� T!I�i
JUN 1 1 2012
BY:
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.
Robertson, Kelley Terms
13613 Stone Haven Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/8/12 842903 Refund 45.00
Total 45.00
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.
Robertson, Kelley Allowed 20
13613 Stone Haven Dr
Carmel, IN 46033
In Sum of
45.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -7 842903 4358400 45.00 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
14 -Jun 2012
Signature
45.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund