HomeMy WebLinkAbout244563 04/21/15 /�+.cegs� CITY OF CARMEL, INDIANA VENDOR: 369289
j; ONE CIVIC SQUARE MICHAEL QUIGLEY CHECK AMOUNT: $••"•"361.33`
CARMEL, INDIANA 46032 1216 SHADOW RIDGE CHECK NUMBER: 244563
'Mi(TON^�?a INDIANAPOLIS IN 46280 CHECK DATE: 04/21/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 361.33 PARKS DEPARTMENT REFU
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GLOBAL REFUND RECEIPT
Receipt# 1429748Carmel " � 7
Payment Date: 8002 2015 ! rks&Recreation
Household#: soo2 APR 13 2015 . `
Home Phone: (317)796-9925
MICHAEL QUIGLEY Monon Community Center
1216 SHADOW RIDGE Carmel IN 46032
INDIANAPOLIS IN 46280
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION -Refund Of 361.33
Pass Holder: Michael Quigley Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Senr Annual (M MCSA),#274960 58.67 0.00 58.67 0.00 0.00
Valid Dates: 02/12/2015 to 02/12/2016 (Pass Cancellation)
Cancellation Effective: 04/04/2015
Fee Details: Fee Descriation _ _ Amount Count Discount Sales Tax _.Total Fee
nAnnual MC Pass 58.67 1.00 0.00 0.00 58.67
Cancel Reason: silver sneakers
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 04/04/15 @ 17:44:49 by HPG FEES CHANGED ON CANCELLED ITEMS(+) 361.33-
DISCOUNT APPLIED AGAINST,CANCELLED FEES(-) 0.00
SALES TAX CHARGED ON CANCELLED FEES(+) 0.00
NET AMOUNT FROM CANCELLED ITEMS 361:33-
TOTAL AMOUNT REFUNDED _ 361.33
Ll j v 0 NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 361.33 Made By=_>REFUND FINAN With Reference==>staff error check
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued. _
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y1
Authorized 'gnature 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.
Quigley, Michael Terms
1216 Shadow Ridge Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/4/15 1429748 Refund $ 361.33
Total $ 361.33
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with I G 5-11-10-1.6
20_
Clerk-Treasurer
II
Voucher No. Warrant No. �+
Quigley, Michael Allowed 20
1216 Shadow Ridge
Indianapolis, IN 46280 '
In Sum of$
$ 361.33 !
L
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1092 1429748 4358400 $ 361.33 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
I
which charge is made were ordered and
received except
i April 16, 2015
I
I
I Signature
$ 361.33 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund l'