251474 11/18/15 0,C19 .
*� CITY OF CARMEL, INDIANA VENDOR: 370061
® ONE CIVIC SQUARE ADRIENNE BELLOMO CHECK AMOUNT: S""'"""124.00'
r` CARMEL, INDIANA 46032 1519 REDWOOD DRIVE CHECK NUMBER: 251474
<;,,roN, CARMEL IN 46032 CHECK DATE: 11/18/15
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 124.00 REFUNDS AWARDS & INDE
R eipt#2000171.004 Page 1 of 1
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Monon Community Center Wet E `5 ouches' #2000171.004
Building Oct 30, 2015 11:57 AM
1195 Central Park Dr. West �Y"— - ---- -
Carmel, IN 46032
Phone: (317) 848-7275 '0� lay
FAX: - d Im It E
-
Email: info@carmelclayparks.com
Parks&m.-creaA-ion
NATIONAL GOLD MEDAL WINNER
ADRIENNE BELLOMO D ACCREDITED AGENCY
1519 REDWOOD DR.
CARMEL, IN 46032
Prepared By: markt
Customer ID: 9830
Primary phone: (619) 569-6498, Secondary phone: (619) 569-6709
Refund Summary }
Check: ($93.00) Check #
Total Received: ($93.00) Total Refund: ($93.00)
Transactions
Customer Description Item Unit Qty Fee Charge
Adrienne Bellomo Escape Pass-Corporate Adult Monthly Membership Each 1.00 $31.00 ($31.00)
1519 Redwood Dr. Action: Membership Refund Fee
Carmel,IN 46032 Expires: Aug 15, 2015
Primary phone:(619)569- Pass # 130015898: Adrienne Bellomo
6498 Thanks for your purchase! This pass will
Email:amgII12@gmail.com automatically renew each month, until cancellation
ID:9830 request is received. Cancellation request must be
received 7 days prior to billing date.
Adrienne Bellomo Escape Pass-Corporate Adult Monthly Membership Each 1.00 $31.00 ($31.00)
1519 Redwood Dr. Action: Membership Refund Fee
Carmel,IN 46032 Expires: Sep 15, 2015
Primary phone:(619)569- Pass # 130015898: Adrienne Bellomo
6498 Thanks for your purchase! This pass will
Email:amg1112@gmail.com automatically renew each month, until cancellation
ID:9830 request is received. Cancellation request must be
received 7 days prior to billing date.
Adrienne Bellomo Escape Pass-Corporate Adult Monthly Membership Each 1.00 $31.00 ($31.00)
1519 Redwood Dr. Action: Membership Refund Fee
Carmel,IN 46032 Expires: Oct 15, 2015
Primary phone:(619)569- Pass # 130015898: Adrienne Bellomo
6498 Thanks for your purchase!This pass will
Email:amg1112@gmail.com automatically renew each month, until cancellation
ID:9830 request is received.Cancellation request must be
received 7 days prior to billing date.
Total Charges ($93.00)
Total Payments ($93.00)
Balance $0
Federal Tax ID # 35-6000972
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https://activenet023.active.com/carmelcIayparks/servlet/processReceiptPayment.sdi 10/30/2015
Receipt 42000170.004 Page 1 of 1
Monon Community Center Wet N :"l - Z 2015 Voucher #2000170.004
Building Oct 30, 2015 11:50 AM
1195 Central Park Dr. WestY
Carmel, IN 46032
Phone: (317) 848-7275
FAX: -- lay
Email:
info@carmelclayparks.com t'ks&Recrea-Lion
NATIONAL GOLD MEDAL WINNER
ADRIENNE BELLOMO AND C C R E I T ED AGENCY
1519 REDWOOD DR.
CARMEL, IN 46032
Prepared By: markc
Customer ID: 9830
Primary phone: (619) 569-6498, Secondary phone: (619) 569-6709
Refund Summary
Check: ($31.00) Check #
Total Received: ($31.00) Total Refund: ($31.00)
Transactions
Customer Description Item Unit Qty Fee Charge
Adrienne Bellomo Escape Pass- Membership Each 1.00 $31.00 ($31.00)
1519 Redwood Dr. Corporate Adult Fee
Carmel,IN 46032 Monthly
Primary phone: Action:Membership
(619)569-6498 Refund
Email: Expires:Jul 15,
amg1112@gmail.com 2015
ID:9830 Pass# 130015898:
Adrienne Bellomo
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 ($31.00)
Total Payments ($31.00)
Balance $0
Federal Tax ID # 35-6000972
1030/1
toga. ti3sF-voo
SfAff Erro I'
https:Hactivenet023.active.com/carmelelayparks/servlet/ShowReceipt.sdi?receipthead... 10/30/2015
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.
Bellomo, Adrienne Terms
1519 Redwood Drive Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/30/15 2000171004 Refund $ 93.00
10/30/15 2000170004 Refund $ 31.00
Total $ 124.00
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.
Bellomo, Adrienne Allowed 20
1519 Redwood Drive
Carmel, IN 46032
In Sum of$
$ 124.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1092 2000171004 4358400 $ 93.00 1 hereby certify that the attached invoice(s), or
1092 2000170004 4358400 $ 31.00 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
'l '-Vo v
Signature
$ 124.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund