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Home My WebLink About228955 2/11/2014 CITY OF CARMEL, INDIANA VENDOR: 367940 Page 1 of 1 ONE CIVIC SQUARE SUSAN CHAMBERLIN CHECK AMOUNT: $35.00 CARMEL, INDIANA 46032 922 CHEVY CHASE LANE INDIANAPOLIS IN 46280 CHECK NUMBER: 228955 CHECK DATE: 2/11/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1092 4358400 35 . 00 REFUNDS AWARDS & INDE GLOBAL REFUND RECEIPT Receipt# 1202035 tj s ___ [' rel o Clay Payment Date: 01/28/2014 � '•+ Household #: 48421 Parks&Recreafioh Home Phone: (478)550-0443 JAN 9 Y 2814 Work Phone: (317)574-0101 BY: SUSAN CHAMBERLIN Monon Community Center 9648 Q1-i—G iii '�' -- — Carmel IN 46032 vr�iv� PoLag StJ Lt(c 2� #35-6 Phone: (31 7275 Fed Tax ID#35-6000972 Pass Details CANCELLATION Pass Holder: Susan Chamberlin Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC Adlt Mthly (M MCAM), #171559 420.00 0.00 420.00 0.00 0.00 Valid Dates: 06/01/2012 to 06/01/2013 (Pass Cancellation) Cancellation Effective: 01/28/2014 Pass Comments: Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee nMonthly MC Pass 420.00 1.00 0.00 0.00 420.00 CANCELLATION - Refund Of 35.00 Pass Holder: Susan Chamberlin Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC Adlt Mthly (M MCAM), #171559 245.00 0.00 245.00 0.00 0.00 Valid Dates: 06/02/2013 to 06/01/2014 (Pass Cancellation) Cancellation Effective: 01/28/2014 Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee nMonthly MC Pass 245.00 1.00 0.00 0.00 245.00 Cancel Reason: Missed January cancellation. Susan has moved. PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 01/28/14 @ 14:00:16 by DMLEONARD FEES CHANGED ON CANCELLED ITEMS(+) 35.00- DISCOUNT APPLIED AGAINST CANCELLED FEES( ) 0.00 SALES TAX CHARGED ON CANCELLED FEES(+) 0.00 NET AMOUNT FROM"CANCELLED ITEMS. 35.00= TOTAL AMOUNT REFUNDED-1 NEW NET HOUSEHOLD BALANCE 0.00 Refund of=_> 35.00 Made By==>REFUND FINAN With Reference==>missed cancellation;DML /0 BIZ, y00 Page# 1 of 2 GLOBAL REFUND RECEIPT .C` � � J�/ Receipt# 1202035 rksAecmAion Payment Date: 01/28/2014 Household #: 48421 All refunds are subject to State Board of Accounts procedures and may take 4-6 w o process. No cash refunds will be issued. l L I Authorized Signature Date Authori S' nature 6ate Escape Day Passes are non-refundable. Page# 2 of 2 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. Chamberlin, Susan Terms 922 Chevy Chase Ln Date Due Indianapolis, IN 46280 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 1/28/14 1202035 Refund $ 35.00 Total $ 35.00 1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 _120 Clerk-Treasurer I Voucher No. Warrant No. Chamberlin, Susan Allowed 20 922 Chevy Chase Ln Indianapolis, IN 46280 In Sum of$ $ 35.00 ON ACCOUNT OF APPROPRIATION FOR 109 - MCC PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1092 1202035 4358400 $ 35.00 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 7-Feb 2014 Signature $ 35.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund