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224581 09/25/2013 CITY OF CARMEL, INDIANA VENDOR: 365275 Page 1 of 1 ONE CIVIC SQUARE SUDHARANI MAMIDIPALLI CARMEL, INDIANA 46032 5743 KENDERLY COURT CHECK AMOUNT: $121.50 CARMEL IN 46033 CHECK NUMBER: 224581 CHECK DATE: 9/25/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4358400 1146065 121 . 50 REFUNDS AWARDS & INDE GLOBAL REFUND RECEIPT Receipt# 1146065 eI Clay Payment Date: 09/06/13 Parks J Household #: 11293 Woodbrook Elementary _ Sudharani Mamidipalli Hm Ph: (317)873-4746 4311 East 116th Street SEp j �0j3 5743 Kenderly Court Carmel IN 46033 Carmel IN 46033 Cell Ph:(317)625-0857 sranin@yahoo.com Phone: (317)848-7275 ]BY _ Fed Tax ID #35-6000972 Pass Details CANCELLATION - Refund Of 121.50 Pass Holder: Laasya Mamidipalli Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: 10-Visit(ESE1 OV), #182757 13.50 0.00 13.50 0.00 0.00 Valid Dates: 08/15/2012 to 05/29/2013 (Pass Cancellation) Cancellation Effective: 09/06/2013 Cancel Reason: No longer in ESE. Refund remaining passes. NUP PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 09/06/13 Q 15:54:46 by NUP FEES CHANGED ON CANCELLED ITEMS(+) 121.50- NET AMOUNT.-FROM CANCELLE131TEMS '°121:50 TOTALAMOUNT,"REFUNDED'" ""121:50 NEW NET HOUSEHOLD BALANCE 0.00 Refund of=_> 121.50 Made By==>REFUND FINAN With Reference==>1081-1� 4858 00 3 y3Syq©O ( All refunds e subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds wi I be issued. Aut on Signature Date Authorized Signature Date Escape 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. Mamidipalli, Sudharani Terms 5743 Kenderly Court Date Due Carmel, IN 46033 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 9/6/13 1146065 Refund $ 121.50 Total $ 121.50 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. Mamidipalli, Sudharani Allowed 20 5743 Kenderly Court Carmel, IN 46033 In Sum of$ $ 121.50 ON ACCOUNT OF APPROPRIATION FOR 108 - ESE PO#or Board Members Dept# INVOICE NO. ACCT#/TITLE AMOUNT 1081-11 1146065 4358400 $ 121.50 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 19-Sep 2013 Y-9)&A�,Ml� Signature $ 121.50 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund