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Home My WebLink About232976 05/28/14 ,�w.cQpMf v: CITY OF CARMEL, INDIANA VENDOR: 360717 '_ @' ONE CIVIC SQUARE KIM ADELSPERGER CHECK AMOUNT: $********95.00* s ,_� CARMEL, INDIANA 46032 3852 MINUTE MAN CIRCLE CHECK NUMBER: 232976 9M,i�oN�b CARMEL IN 46032 CHECK DATE: 05/28/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1092 4358400 1252699 95.00 REFUNDS AWARDS & INDE GLOBAL REFUND RECEIPT Receipt# 1252699 .( � Q Payment Date: 05/15/2014 FBY: �. rls +crearon Household#. 7611 � h Home Phone: (317)733-8086 Work Phone: (317)582-7665 014 KIM ADELSPERGER Monon Community Center 3852 MINUTE MAN CIRCLE Carmel IN 46032 CARMEL IN 46032 Phone: (317)848-7275 Fed Tax ID#35-6000972 Pass Details CANCELLATION Pass Holder: Kim Adelsperger Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH+(M MCHH+),#242527 0.00 0.00 0.00 0.00 0.00 Valid Dates: 05/05/2014 to 05/05/2015 (Pass Cancellation) Cancellation Effective: 05/15/2014 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: no more st Vincent discount CANCELLATION -Refund Of 95.00 Pass Holder: Aaron Adelsperger Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH Mthly(M MCHHM),#242526 0.00 0.00 0.00 0.00 0.00 Valid Dates: 05/05/2014 to 05/05/2015 (Pass Cancellation) Cancellation Effective: 05/15/2014 Cancel Reason: no more st Vincent discount CANCELLATION Pass Holder: Graham Adelsperger Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH+ (M MCHH+),#242528 0.00 0.00 0.00 0.00 0.00 Valid Dates: 05/05/2014 to 05/05/2015 (Pass Cancellation) Cancellation Effective: 05/15/2014 cancel Reason: no more st Vincent discount CANCELLATION Pass Holder: Miles Adelsperger Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH+(M MCHH+),#242529 0.00 0.00 0.00 0.00 0.00 Valid Dates: 05/05/2014 to 05/05/2015 (Pass Cancellation) Cancellation Effective: 05/15/2014 Cancel Reason: no more st Vincent discount Page# 1 of 2 GLOBAL REFUND RECEIPT ' rme.-I � la Receipt# 1252699 -Oaik�ilke6-ro*at1C3t1 7MAY F__75 , Payment Date: 05/15/2014 Household M 7611 -. 2014 i :Bt-v': CANCELLATION Pass Holder: Meredith Adelsperger Fees+Tax Discount Prev Paid Cur Paid .Amount Due Pass Type: MC HH+ (M MCHH+),#242530 0.00 0.00 0.00 0.00 0.00 Valid Dates: 05/05/2014 to 05/05/2015 (Pass Cancellation) Cancellation Effective: 05/15/2014 Cancel Reason: no more st vincent discount i K0401A;� Caulce.ZU,*ugn -FWK UYI �{ . PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 05/15/14 @-11:13:58 by KHOBLIK FEES CHANGED ON CANCELLED ITEMS(+) - 95.00- DISCOUNT APPLIED AGAINST CANCELLED FEES(-) 0.00 SALES TAX CHARGED ON CANCELLED FEES(+) 0.00 NET-AMOUNT FROM CANCELLED ITEMS 95.00-. TOTAL AMOUNT REFUNDED 95.00 lyJ �( In NEW NET HOUSEHOLD BALANCE 0.00 Refund of=_> 95.00 Made By=_>REFUND FINAN With Reference=_>Staff error All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be issued. 2L Authorized ignature Date Authorized Signature Date Escape Day Passes are non-refundable. ylmo( A-0 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. Adelsperger, Kim Terms 3852 Minute Man Circle Date Due Carmel, IN 46032 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/15/14 1252699 Refund $ 95.00 Total $ 95.00 I 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 i Voucher No. Warrant No. � Adelsperger, Kim Allowed 20 3852 Minute Man Circle Carmel, IN 46032 In Sum of$ $ 95.00 i ON ACCOUNT OF APPROPRIATION FOR 109 -MCC PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1092 1252699 4358400 $ 95.00 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 22-May 2014 Signature $ 95.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund