225003 10/08/2013 CITY OF CARMEL, INDIANA VENDOR: 367646 Page 1 of 1
0 ONE CIVIC SQUARE SHERRI MOORE
CARMEL, INDIANA 46032 3610 TARA COURT CHECK AMOUNT: $61.50
? WESTFIELD IN 46074
CHECK NUMBER: 225003
CHECK DATE: 10/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 61 . 50 REFUNDS AWARDS & INDE
PASS REFUND RECEIPT
Receipt# 1155805
� i _. ����' Payment Date: 10/01/13
Household #: 19165
Parks&recreation OCT 0 1 2013
,BY: I
Monon Community Center herri Moore Hm Ph: (317)379-7562
Carmel IN 46032 3610 Tara Court
Westfield IN 46074 Cell Ph:
mooresherri@yahoo.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION - Refund Of 61.50
Pass Holder: Sherri Moore Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: KZ 50 Visit(M Z50), #27204 13.50 0.00 13.50 0.00 0.00
Valid Dates: 06/06/2008 to 12/31/2099 (Pass Cancellation)
Cancellation Effective: 10/01/2013
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10/01/13 @ 11:18:31 by LVA FEES CHANGED ON CANCELLED ITEMS(+) 61.50-
NET AMOUNT FROM CANCELLED ITEMS 61.50-
TOTAL AMOUNT REFUNDED 61.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 61.50 Made By==>REFUND FINAN With Reference==>prorated request
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issu
l o r ,®
Authorized Sig a re Datef A Auth rize 'Signature Date
Escape Day Passes are non-refundable.
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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.
Moore, Sherri Terms
3610 Tara Court Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/1/13 1155805 Refund $ 61.50
Total $ 61.50
1 hereby certify that the attached invoice(s), or bill(s)is(are)true and correct and I have audited same in accordance
with I C 5-11-10-1.6
, 20
Clerk-Treasurer
Voucher No. Warrant No.
Moore, Sherri Allowed 20
3610 Tara Court
Westfield, IN 46074
In Sum of$
$ 61.50
ON ACCOUNT OF APPROPRIATION FOR
109 - MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-41 1155805 4358400 $ 61.50 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
4-Oct 2013
Signature
$ 61.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund