251499 11/18/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 362799
ONE CIVIC SQUARE LEE COOLIDGE CHECK AMOUNT: S""""""""14.00*
CARMEL, INDIANA 46032 799 BENNETT COURT CHECK NUMBER: 251499
CARMEL IN 46032 CHECK DATE: 11/18/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 14.00 REFUNDS AWARDS & INDE
Receipt #2000165.004 Page I of 1
Monon Community Center Wes Voucher #2000165°004
Building NOV - 3 L015 Oct 22, 2015 5:07 PM
1195 Central Park Dr. West ( (Duplicate Receipt)
Carmel, IN 46032
Phone: (317) 848-7275 BY' _ -
-,-rmel o C at jr
Email: Cd, 111 1
info@carmelclayparks.com �arks&Recraion
NATIONAL GOLD MEDAL WINNER
LEE COOLIDGE AND ACCREDITED AGENCY
799 BENNETT CT.
CARMEL, IN 46032
Prepared By: hollypg
Customer ID: 4491
Primary phone: (317) 538-9441, Secondary phone: --
FRefund Summary - ------ ------- -- ------- -- ----
Check: ($14.00) Check #
Total Received: ($14.00) Total Refund: ($14.00)
Transactions - — _ ----- _ -- -- ----- _ ----- ------1
Customer Description Item Unit Qty Fee Charge
Lee Coolidge Escape Pass- Membership Each 1.00 $14.00 ($14.00)
799 Bennett Ct. Adult Monthly Fee
Carmel,IN 46032 Action: Membership
Primary phone: Refund
(317)536-9441 Expires: Nov 15,
Email: 2015
lcooh@yahoo.com Pass# 130002320:
ID:4491 Lee Coolidge
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 ($14.00)
Total Payments ($14.00)
Balance $0
Federal Tax ID # 35-6000972
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09Z u -3s �y�
https://activenet023.active.com/earnielclayparks/servlet/ShowReceipt.sdi?receiptheade... 11/2/2015
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.
Coolidge, Lee
799 Bennett Ct Terms
Carmel, IN 46032 Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s))
Amount
10/22/15 2000165004 Refund
$ 14.00
ETotal $ 14.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Coolidge, Lee Allowed 20
799 Bennett Ct
Carmel, IN 46032
In Sum of$
$ 14.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
-----------------
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITLE AMOUNT
1092 12000165004 4358400 $ 14.00 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
November 3, 2015
pkk&ni��
Signature
$ 14.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund