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309228 03/16/17 -9 �` CITY OF CARMEL, INDIANA VENDOR: 371558 d, tf ONE CIVIC SQUARE JIM COLLINS CHECK AMOUNT: .....198.00' ?�; CARMEL, INDIANA 46032 651 E COLUMBINE DRIVE CHECK NUMBER: 309228 .-;�i�oN.�. WESTFIELD IN 46074 CHECK DATE: 03/16/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1092 4358400 2000528004 198.00 REFUNDS AWARDS & INDE \ cc) (D z � K aq f CD o K) 0 40 $ $ � f E / 0 2 O m _ 2 $ \ k % mEn ± J k m w / % \ \ k k 23 i � A n k / & / ® 00 % k J § $ q # 9 m C) _ \ 03 k / D w � / 7 > 3 g 2 © / \ 0 FO ¥ CD k § R 2 k o CD § f / \ § % < ::r � § & \ z l< CL q ° / Q � > q ? R + o F — / ] ƒ ( \ m 0 m m @ 0 2� . J — \ k 0 % \ § \ co \ k \ / CD w (D » q & CD . \ / % / k 2 0 $ & ~ M 7 | 2 7 7 E o �Rece;<pt#2000528:004 Page 1 of 1 MAR 0 8 201 Monon Community Center Wes BY: oucher #2000528.004 Building Mar 6 2017 9.14 PM 1195 Central Park Dr. West Carmel, IN 46032 Phone: (317) 848-7275 * Clay FAX: -- ' Car e Email. info@carmelclayparks.com• inf carmelcla arks.com Parks&Recreation NATIONAL GOLD MEDAL WINNER E COL S AND ACCREDITED AGENCY 1553 WIE DR. WE FIEL , N 46074 J' Cpl IKS Prepared By: hollypg f-• C01Vvhb�v1e Dv' Customer ID: 3356 �� � � �t� Primary phone: (317) 513-8291, Secondary phone: -- Refund Summary Check: ($198.00) Check # Total Received: ($198.00) Total Refund: ($198.00) Transactions Customer Description Item Unit Qty Fee Charge Andrew Collins Escape Pass- Household Monthly Membership Each 1.00 $99.00 ($99.00) 15535 Bowie Dr. Action: Membership Refund Fee Westfield,IN 46074 Expires: Feb 15, 2017 Primary phone:(317)513- 15 Passes Sold 8291 Pass # 130001959: Andrew Collins Email:collins3@indy.rr.com Pass# 130037534: Jim Collins ID: 3359 Pass # 130001957: Zachary Collins 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. Andrew Collins Escape Pass- Household Monthly Membership Each 1.00 $99.00 ($99.00) 15535 Bowie Dr. Action: Membership Cancel Fee Westfield,IN 46074 Expires: Feb 15, 2017 Primary phone:(317)513- 15 Passes Sold 8291 Pass# 130001959: Andrew Collins Email:collins3@indy.rr.com Pass # 130037534: Jim Collins ID:3359 Pass# 130001957: Zachary Collins 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 ($198.00) Total Payments ($198.00) Balance $0 Federal Tax ID # 35-6000972 https://anprod.active.com/cannelclayparks/servlet/ReceiptFinish.sdi?mo=1&sdiregauth=148... 3/6/2017