246704 06/30/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 369518
ONE CIVIC SQUARE CHADD BAUGHER CHECK AMOUNT: $*******"99.00"
CARMEL, INDIANA 46032 347 3RD AVE NE CHECK NUMBER: 246704
CARMEL IN 46032 CHECK DATE: 06/30/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 REFUND 99.00 1453162
a
PASS REFUND RECEIPT
Receipt 1453162
Payment Date: 06/16/2015
Household#: 49212 4 - _ - . _ - r S R ;.0 q'a ion.
Home Phone: (317)441-3597 }
JUN 19 2015
CHADD BAUGHER Monon Community Center
347 3 RD AVE NE Carmel IN 46032
CARMEL IN 46032
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION -Refund Of 99.00
Pass Holder: Chadd Baugher Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH Mthly(M MCHHM),#175307 966.00 0.00 966.00 0.00 0.00
Valid Dates: 07/14/2014 to 07/13/2015 (Pass Cancellation)
Cancellation Effective: 06/16/2015
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
nMonthly MC Pass 966.00 1.00 0.00 0.00 966.00
Cancel Reason: active
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/16/15 @ 13:19:01 by HPG FEES CHANGED ON CANCELLED ITEMS(+) 99.00-
DISCOUNT APPLIED AGAINST CANCELLED FEES(-) 0.00
SALES TAX CHARGED ON CANCELLED FEES(+) 0.00
NET AMOUNT FROM CANCELLED ITEMS 99.00-
/ _ TOTAL AMOUNT REFUNDED 99.00
�� 6 `09 Z �T q� )( ) NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 99.00 Made By=_>REFUND FINAN With Reference=_>check guest request
All refunds are subject to S to Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
22�7L )" S ��
Authorized SigVure 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.
Baugher, Chadd Terms
347 3rd Ave NE Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number^ (or note attached invoice(s) or bill(s)) Amount
6/16/15 1453162 Refund $ 99.00
Total $ 99.00
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have aud'ted same in accordance
with IC 5-11-10-1.6
20_
Clerk-Treasurer
Voucher No. Warrant No. ,
Baugher, Chadd !Allowed 20
347 3rd Ave NE
Carmel, IN 46032
In Sum of$
$ 99.00 I
I
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
I,.
PO#or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept#
I
1092 1453162 4358400 $ 99.00 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
June 25, 2015
f
Signature
$ 99.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
1f