231401 04/08/14 `�'u ��py� CITY OF CARMEL, INDIANA VENDOR: 368107
® it ONE CIVIC SQUARE HEATHER STANKIEWICZ CHECK AMOUNT: $***"***285.00*
i° CARMEL, INDIANA 46032 755 ALWAYNE ROAD CHECK NUMBER: 231401
'b�iori- � CARMEL IN 46032 CHECK DATE: 04/08/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 1230073 285.00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1230073
r 1 Payment Date: 03/28/14
Household #: 21857
Irks&Recreatlion
MAR 28 2014
Monon Community Center r. Heather Stankiewicz Hm Ph: (317)569-0473
Carmel IN 46032 �____ — ___ _ 755 Alwyne Rd
y Carmel IN 46032 Cell Ph:(317)690-4628
hstankiewicz@gmail.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION -Refund Of 285.00
Pass Holder: Kevin Stankiewicz Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH Mthly (M MCHHM),#90431 855.00 0.00 855.00 0.00 0.00
Valid Dates: 12/15/2012 to 12/14/2013 (Pass Cancellation)
Canceiiation e=ffective: 03/28/20"14
Pass Comments: Children must be age 11 or older to utilize the pools and/or gymnasium unaccompanied by an adult.
Children ages 11-13 may use Fitness Center, but must be under adullt supervision.
Children must be age 14+to utilize the Fitness Center without adult supervision.
Cancel Reason: staff error
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 03/28/14 @ 10:05:35 by JWH FEES CHANGED ON CANCELLED ITEMS(+) 285.00-
�JtNET'AMOUNT.EFROM.CANCELLED'ITEMS' t�, 285.00-''
TOTAL AMOUNT REFUNDED 285.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 285.00 Made By==>REFUND FINAN With Reference==>
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
If
,;�I�k
uthorized 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.
Stankiewicz, Heather Terms
755 Alwyne Rd Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/28/14 1230073 Refund $ 285.00
Total $ 285.00
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
Voucher No. Warrant No.
Stankiewicz, Heather Allowed 20
755 Alwyne Rd
Carmel, IN 46032
In Sum of$
I
$ 285.00
ON ACCOUNT OF APPROPRIATION FOR
109 - MCC
PO#orBoard Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1092 1230073 4358400 $ 285.00 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
3-Apr 2014
Signature
$ 285.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund