HomeMy WebLinkAbout210306 07/05/2012 CITY OF CARMEL, INDIANA VENDOR: 366324 Page 1 of 1
0 ONE CIVIC SQUARE ASHLEY CHAMBERLAIN CHECK AMOUNT: $56.00
CARMEL, INDIANA 46032 3066 APILITA COURT
CARMEL IN 46033 CHECK NUMBER: 210306
CHECK DATE: 7/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 56.00 REFUNDS AWARDS INDE
GLOBAL REFUND RECEIPT
Receipt 855303
6 ,p Payment Date: 06/15/12 le Household 27482
i`ks R�cr attc n
Monon Community Center EY IVEID Ashley Chamberlain Hm Ph: (317)331 -7810
Carmel IN 46Q32 3066 Apilita Ct.
Phone: (317)848 -7275
9 2012 Ca rmel IN 46033 Cell Ph:
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 56.00
Pass Holder: Ashley Chamberlain Fees +Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: FIT Adlt Mnthly (XM FTAM), #70463 112.00 0.00 0.00 112.00 0.00
Valid Dates: 01/15/2012 to 01/ 3 (Pass Cancellation)
Cancellation Effective: 06/15/201
Cancel Reason: emailed JBroman cancellation on 5/7/12.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/15/12 10:29:07 by TLP FEES CHANGED ON CANCELLED ITEMS 168.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 112.00
NET -AMOUNT;F.ROM;CANCELLED:ITEMS 56;00-
TOTAL'AMOUNT�REF.UNDED'..'
i
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 56.00 Made By REFUND FINAN With Reference emailed JBroman 5/7
All refunds are subject t, Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No c or cr i c r refunds.
4Aut� th ri ed Signatu ate g u
Au re 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: //2011 cpry .theregistrationsystem.com /en 1033
DAY PASSES ARE NON REFUNDABLE
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.
Terms
Chamberlain, Ashley Date Due
3066 Apilita Ct
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/15/12 855303 Refund 56.00
Total 56.00
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
r
s
Voucher No. Warrant No.
Allowed 20
r Chamberlain, Ashley
3066 Apilita Ct
Carmel, IN 46033 In Sum of
56.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 855303 4358400 56.00 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
28 -Jun 2012
PJjVjTnr'YU�
Signature
56.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund