HomeMy WebLinkAbout211234 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: T357626 Page 1 of 1
ONE CIVIC SQUARE ALISON BURKHARD
CARMEL, INDIANA 46032 12420 BROOKSHIRE PKWY CHECK AMOUNT: $12.50
.� ?. CARMEL IN 46033
CHECK NUMBER: 211234
CHECK DATE: 7131/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 912074 12 . 50 REFUNDS AWARDS & INDE
PASS REFUND RECEIPT
Receipt# 912074
Carmel o ay RECE-11 VE D Payment Date: 07/24/12
Parks&Re reation JUL 2 5 2012 Household#: 2910 Mohawk Trails Elemen _ J Alison Burkhard Hm Ph: (317)581-0393
4242 East 126th Street 12420 Brookshire Pky Wk Ph: (317)896-3820
Carmel IN 46033 Carmel IN 46033 Cell Ph:(317)979-4355
alison0630 @sbcgloba1.net
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION - Refund Of 12.50
Pass Holder: Samuel Burkhard Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 20-Visit (ESE20V), #42643 237.50 0.00 237.50 0.00 0.00
Valid Dates: 08/10/2010 to 05/31/2012 (Pass Cancellation)
Cancellation Effective: 07/24/2012
Cancel Reason: ESE no longer needed
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/24/12 @ 15:15:57 by CIVIC FEES CHANGED ON CANCELLED ITEMS(+) 12.50-
NET AMOUNT FROM CANCELLED ITEMS 12.50-
TOTAL AMOUNT REFUNDED 12.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 12.50 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. cash or credit card refunds.
trize gnature 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://2011cpry.theregistrationsystem.com/en/1033!
DAY PASSES ARE NON-REFUNDABLE
4S
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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.
Burkhard, Alison Terms
12420 Brookshire Pky Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)) Amount
7124112 912074 Refund $ 12.50
Total $ 12.50
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.
Burkhard, Alison Allowed 20
12420 Brookshire Pky
Carmel, IN 46033
In Sum of$
$ 12.50
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-5 912074 4358400 $ 12.50 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
26-Jul 2012
Signature
$ 12.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund