240834 01/07/15 CITY OF CARMEL, INDIANA VENDOR: 369010
ONE CIVIC SQUARE MARY SUTTON CHECK AMOUNT: $*—*'�150.00*
�, as CARMEL, INDIANA 46032 12037 WATERFORD LANE CHECK NUMBER: 240834
"M,iaN�o CARMEL IN 46033 CHECK DATE: 01/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 150.00 REFUNDS AWARDS & INDE
GLOBAL REFUND-RECEIPT
Receipt# 1384156 €7 rm I I el 0--clay,
Payment Date: 12/29/2014 '
Household#: 52167 f'�Cs&R(rGFt', _ ion
Home Phone: (317)846-2945
MARY SUTTON DEC 3 0 2014 Monon Community Center
12037 WATERFORD LN Carmel IN 46032
CARMEL IN 46033
BY:
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION - Refund Of 150.00
Pass Holder: Donald Buckley Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: UnGrpFit Annual (M UGFA), #249424 150.00 0.00 150.00 0.00 0.00
Valid Dates: 07/03/2014 to 07/03/2015 (Pass Cancellation)
Cancellation Effective: 12/29/2014
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
nFitness Prog Passes 150.00 1.00 0.00 0.00 150.00
Cancel Reason: =Guest request:r
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 12/29/14 @ 16:34:40 by DMLEONARD FEES CHANGED ON CANCELLED ITEMS(+) 150.00-
DISCOUNT APPLIED AGAINST CANCELLED FEES(-) 0.00
SALES TAX CHARGED ON CANCELLED FEES(+) 0.00
NET AMOUNT FROM'.CANCELLEDJTEMS 150:00-
.TOTAL AMOUNT REFUNDED. 150.00 .
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 150.00 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.
Authorized 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.
Sutton, Mary Terms
12037 Waterford Ln Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/29/14 1384156 Refund $ 150.00
Total $ 150.00
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
Voucher No. Warrant No.
Sutton, Mary Allowed 20
12037 Waterford Ln
Carmel, IN 46033
In Sum of$
$ 150.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITL AMOUNT
1092 1384156 4358400 $ 150.00 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
$ 150.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund