240864 01/07/15 +us cngM
. CITY OF CARMEL, INDIANA VENDOR: 369008
d iI ONE CIVIC SQUARE DIANE CHILDERS CHECK AMOUNT: $ `"'*`200.00*
CARMEL, INDIANA 46032 12757 KIAWAH DR CHECK NUMBER: 240864
CARMEL IN 46033 CHECK DATE: 01/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 200.00 REFUND
PASS REFUND RECEIPT
Receipt# 1382298 Carmel o Clay
Payment Date: 12/22/2014
Household#: 33390 Parks&Recreation
Home Phone: (317)846-6113
7 D
DEC 29 2014
DIANE CHILDERS �B --__--_______ Monon Community Center
12757 KIAWAH DR Carmel IN 46032
CARMEL IN 46033
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass D'6taiis
MEMBERSHIP CHANGE - Refund Of 200.00
Pass Holder: Diane Childers Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: UnGrpFit Annual (M UGFA),#254560 100.00 0.00 100.00 0.00 0.00
Valid Dates: 08/21/2014 to 08/21/2015 (Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
nFitness Prog Passes 100.00 1.00 0.00 0.00 100.00
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 12/22/14 @ 11:26:51 by HPG FEES ADJUSTED ON CHANGED ITEMS(+) 200.00-
DISCOUNT APPLIED AGAINST THESE FEES(-) 0.00
SALES TAX CHARGED ON CHANGED FEES(+) 0.00
NET AMOUNT FROM CHANGED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 200.00
G� r 106
Z_. 64
� ,c6( t v v NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 200.00 Made By==>REFUND FINAN With Reference==>ref finace
All refunds are subject to State Board of
Authorized Sccounts procedures and may take 4-6 weeks to process. No cash refunds will be
—Y—
issued.
/?—/ �L /2—/ C/
i ature Date Authorized Signature D to
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.
Childers, Diane Terms
12757 Kiawah Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/22/14 1382298 Refund $ 200.00
Total $ 200.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Childers, Diane Allowed 20
12757 Kiawah Dr
Carmel, IN 46033
In Sum of$
$ 200.00
ON ACCOUNT OF APPROPRIATION FOR _
109 - MCC
I
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1092 1382298 4358400 $ 200.00 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
January 2, 2015
Signature
$ 200.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund