211509 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 366434 Page 1 of 1
t ONE CIVIC SQUARE MARIE VICARI
0 CHECK AMOUNT: $674.10
795 GAYER DR
CARMEL, INDIANA 46032
MEDINAOH 44256 CHECK NUMBER: 211509
OM
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4358400 906616 674 . 10 REFUNDS AWARDS & INDE
FACILITY REFUND RECEIPT
Clay # 906616
Carmel o Clay Household #te : 07/19/12
ParkS&ReCFeatlon
Monon Community Center Alex Marshall Hm Ph: (765)534-4682
Carmel IN 46032 13786 E. 216th St. Wk Ph: (317) -
-� 'N7 Noblesville IN 46060 Cell Ph:(317)519-8017
Phone: (317)848-7275
marshallsville @gmail.com
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Fed Tax ID #35-6000972
off,:¢ 447.5(0---7 r'1 J& CkZ&
Facility Reservation Details
CANCELLATION - Refund Of 674.10
Facility: Monon Community Cntr, Banquet Room -All 3 --�,
Reserv.Contact: Alex Marshall, Cell: (317)519-8017 P'�-'�'— `-.", '`'°TED
Resew.Number: Status: Cancelled
Purpose: Marie Vicari Alex Marshall Wedding Reception (RCC) JUL 2 6 2012
Anticipated Count: 1
Date Day Time Fees+Tax Discount Prev Paict—C—irc Paid=Pmoo
12/29/2012 Sat 5:OOP to 10:OOP 674.10 0.00 0.00 674.10 0.00
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
nRental Ritz 630.00 1.00 0.00 44.10 674.10
Cancel Reason: Cannot afford Venue/Catering
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/19/12 @ 11:41:19 by CLL FEES CHANGED ON CANCELLED ITEMS(+) 1,260.00-
SALES TAX CHARGED ON CANCELLED FEES(+) 88.20-
SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 674.10-
,/, NET AMOUNT FROM CANCELLED ITEMS 674.10-
�C�• Oq� —' ��U 0 2-0 TOTAL AMOUNT REFUNDED 674.10
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 674.10 Made By=_> REFUND FINAN With Reference=_>
Ali 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 refunds.
The count for this line item will not be known until after the reservation date. Therefore, both the count and the extension are
left at zero for reservation purposes, but will be updated after the reservation date. As soon as this data is available, you will
be invoiced for the current amount due. Please remit to our office within 10 days of the invoice date.
'712
Authorized Signature Date C Authorized Signature Date
Page# 1 of 2
� 4
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind number of fice,units, price per unit ,dates service rendered, by
rate
whom, rates per day, number of hours, r
Payee Purchase Order No.
Terms
Date Due
Vicari, Marie
795 Gayer Dr.
Medina, OH 44256
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s)) 674.10
7119112 906616 Refund
Total $ 674.10
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.
Allowed 20
Vicari, Marie
795 Gayer Dr.
Medina, OH 44256 In Sum of$
$ 674.10
ON ACCOUNT OF APPROPRIATION FOR _
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1095-3 906616 4358400 $ 674.10 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
Pj(-h NMLA,0�
Signature
$ 674.10 _ Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund