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11/15/2017 Receipt#2002417.003
Monon Community Center East Building Voucher #2002417.003
1235 Central Park Dr. East
Nov 15, 2017 12:59 PM
Carmel, IN 46032
Phone: (317) 848-7275 F
FAX: -- C� Mto.% lay
Email: Info@carmelclayparks.com PaFks&Recreation
ELIZABETH MATTHEWS NATIONAL GOLD MEDAL WINNER
2009 BROUGHTON AND ACCREDITED AGENCY
CARMEL, IN 460327NOCV1
F.775 4%.
6 2017 Prepared By: bennyj
Customer ID: 16295
-BY""""""" Primary phone: (260) 403-3166, Secondary phone: --
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Check: ($75.00) Check #
Total Received: ($75.00) Total Refund: ($75.00)
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Blake Matthews West Clay 10-Visit Pass 10-Visit Each 1.00 $75.00 ($75.00)
2009 Broughton Action: Membership Cancel Pass Fee
Carmel,IN 46032 Expires: Nov 15, 2017
Primary phone: (260)403-3166 Pass # 130030702: Blake Matthews
Email: -- The 10-Visit Pass will rollover from school year-to-school year.
ID: 16297
Total Charges ($75.00)
Total Payments ($75.00)
Balance $0
Federal Tax ID # 35-6000972
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