249335 09/09/15 CITY OF CARMEL, INDIANA VENDOR: 369811
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.� b i• ONE CIVIC SQUARE CHARLIE KITRON CHECK AMOUNT: S*** 99.00*
CARMEL, INDIANA 46032 3028 E VILLAGE PARK N DRIVE CHECK NUMBER: 249335
CARMEL IN 46033 CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4358400 99.00 REFUNDS AWARDS & INDE
Receipt#2000118.004 FAUG
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I
g 2015Monon Community Center West`==� �f Voucher # 2000118.004
Building Aug 27, 2015 2:55 PM
1195 Central Park Dr. West
Carmel, IN 46032
Phone: (317) 848-7275
FAX: - Car el * Clay
-
Email: info@carmelclayparks.com Recreation
Parks&
NATIONAL GOLD MEDAL WINNER
CHARLIE KIAND ACCREDITED AGENCY
3028 E VILLAGEAGE PARK N
DR.
CARMEL, IN 46033
Prepared By: macel
Customer ID: 6488
Primary phone: (317) 358-7542, Secondary phone: --
Refund Summary
Check: ($99.00) Check #
Total Received: ($99.00) Total Refund: ($99.00)
Transactions
Customer Description Item Unit Qty Fee Charge
Charlie Kitron Escape Pass- Household Monthly Membership Each 1.00 $99.00 ($99.00)
3028 E village Park N Dr. Action: Membership Cancel Fee
Carmel,IN 46033 Expires: Aug 15, 2015
Primary phone:(317)358- 15 Passes Sold
7542 Pass# 130033271: Jamie Kitron
Email: kitron@sbcglobal.net Pass# 130021214: Charlie Kitron
ID:6488 Pass # 130021215: Langston Kitron
Thanks for your purchase! This pass will
automatically renew each month, until cancellation
request is received. Cancellation request must be
received 7 days prior to billing date.
Total Charges ($99.00)
Total Payments ($99.00)
Balance $0
Federal Tax ID # 35-6000972
oa
https://activenet023.active.com/cal i-ielclayparks/servlet/processReceiptPayment.sdi 8/27/2015
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.
Terms
Kitron, Charlie
Date Due
3028 E Village Prk N Dr
Carmel, IN 46033
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
$ 99.00
8/27/15 2000118004 Refund
Total $ 99.00
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
20_
Clerk-Treasurer
Voucher No. Warrant No.
Kitron, Charlie Allowed 20
3028 E Village Prk N Dr
Carmel, IN 46033
In Sum of$
$ 99.00
ON ACCOUNT OF APPROPRIATION FOR
I
109 -MCC
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITL AMOUNT
1095 2000118004 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
September 4, 2015
Signature
$ 99.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund