241337 01/22/15 CAA
CITY OF CARMEL, INDIANA VENDOR: 369036
d t ONE CIVIC SQUARE GAYATHRI MUTHU CHECK AMOUNT: S""'"'"31.25'
?� CARMEL, INDIANA 46032 13359 GOLDEN GATE CHECK NUMBER: 241337
'6,�oH Via: WESTFIELD NC 46074 CHECK DATE: 01/22/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 1391170 31.25 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1391170I {,
Payment Date: 01/15/2015
Household#: 44400 I r'ks&R cr0a,Ign
Home Phone: (614)664-1377
GAYATHRI MUTHU JAN 15 2015 Monon Community Center
13359 GOLDEN GATEB� — Carmel IN 46032
WESTFIELD IN 46074 --____
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION -Refund Of 31.25
Pass Holder: Gayathri Muthu Fees+Tax Discount Prev Paid Our Paid Amount Due
Pass Type: UnGrpFit Season (M UGFS),#227785 93.75 0.00 93.75 0.00 0.00
Valid Dates: 12/16/2013 to 04/16/2014 (Pass Cancellation)
Cancellation Effective: 01/15/2015
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
nFitness Prog Passes 93.75 1.00 0.00 0.00 93.75
Cancel Reason: /Guest request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 01/15/15 @ 05:32:59 by DMLEONARD FEES CHANGED ON CANCELLED ITEMS(+) 31.25-
DISCOUNT APPLIED AGAINST CANCELLED FEES() 0.00
SALES TAX CHARGED ON CANCELLED FEES(+) 0.00
NET AMOUNT FROM CANCELLED ITEMS 31.25=
TOTAL AMOUNT REFUNDED.. 31.25
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 31.25 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.
AA�/1 fa I ptiv �,(Q,v� ►/��l ► is
Authorized Sign 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.
Muthu, Gayathri Terms
13359 Golden Gate Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/15/15 1391170 Refund $ 31.25
Total $ 31.25
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.
Muthu, Gayathri Allowed 20
13359 Golden Gate
Westfield, IN 46074
In Sum of$
$ 31.25
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-21 1391170 4358400 $ 31.25 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 22, 2015
Signature
$ 31.25 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund