HomeMy WebLinkAbout216647 01/29/2013 CITY OF CARMEL, INDIANA VENDOR: 366909 Page 1 of 1
ONE CIVIC SQUARE NIKOL BROCCOLO
0 CARMEL, INDIANA 46032 CHECK AMOUNT: $40.00
457 LEEDS CIRCLE
CARMEL IN 46032 CHECK NUMBER: 216647
CHECK DATE: 1/2912013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 40 . 00 REFUNDS AWARDS & INDE
PASS REFUND RECEIPT.
Receipt# 998903
Carmel a Cila Payment Date: 01/21/13
J Household#: 50312
Kirks&Recreatiof7
Monon Community Center JAN 2 2 2013 1 Nikol Broccolo Hm Ph: (317) -
Carmel IN 46032 i 457 Leeds Circle
.-.; Carmel IN 46032 Cell Ph:(317)319-8355
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION - Refund Of 40.00
Pass Holder: Nikol Broccolo Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: KZ 10 Visit(M Z10),#194016 0.00 0.00 0.00 0.00 0.00
Valid Dates: 01/21/2013 to 04/21/2014 (Pass Cancellation)
Cancellation Effective: 01/21/2013
Cancel Reason: advanced request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 01/21/13 @ 12:48:07 by LVA FEES CHANGED ON CANCELLED ITEMS(+) 40.00-
NET AMOUNT FROM CANCELLED ITEMS 40.00- 1-
TOTAL AMOUNT REFUNDED 40.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 40.00 Made By==>REFUND FINAN With Reference==>advanced request
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
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Authorized Signat ate Au on d tature date
Escape Day Passes are non-refundable.
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Page# 1 of 1
II
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.
Broccolo, Nikol Terms
457 Leeds Circle Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/21/13 998903 Refund $ 40.00
Total $ 40.00
1 hereby certify that the attached invoice(s), or bill(s)is(are)true and correct and I have audited same in accordance
with 1C 5-11-10-1.6
120
Clerk-Treasurer
Voucher No. Warrant No.
Broccolo, Nikol Allowed 20
457 Leeds Circle
Carmel, IN 46032
In Sum of$
$ 40.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-41 998903 4358400 $ 40.00 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
24-Jan 2013
Signature
$ 40.00 _ Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund