189239 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 364633 Page 1 of 1
ONE CIVIC SQUARE DONNA ANDERSON
CARMEL, INDIANA 46032 24315 TOLLGATE ROAD CHECK AMOUNT: $45.00
CICEROIN 46034 CHECK NUMBER: 189239
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 45.00 REFUND
LOCKER REFUND RECEIPT
Receipt 503750
Payment Date: 08/13/10
Household 15274
Monon Community Center Donna Anderson Hm Ph: (317)984 -6326
Carmel IN 46032 24315 Tollgate Rd.
Cicero IN 46034 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Locker Registration Details:
CANCELLATION Refund Of 45.00
Member Name: Donna Anderson Fees Tax Discount Prev Paid Cur Paid Amount Due
Locker Room. Fitness Center Women 15.00 0.00 0.00 15.00 0.00
Locker Number: 106
Valid Dates: 05/01/10 to 05/01/11
Cancel Reason: Ended membership.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/13/10 13:39:48 by LWW FEES CHANGED ON CANCELLED ITEMS 60.00
SURCHARGE APPLIED AGAINST CANCELLED FEES O 15.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 45.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 45.00 Made By REFUND FINAN With Reference locker cancellation
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No cash or credit card refunds.
i
Authorized Signature Date Authorized Signature Date
ENJOY YOUR ESCAPEW f ()q 10 2- 1.. 3 (,::,oCj f a ^1 t
J
Page 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.
Terms
Anderson, Donna
24315 Tollgate Rd. Date Due
Cicero, IN 46034
invoice Invoice Description
Date Number invoice(s) or bill(s)}
or note attached invo Amount
45.00
8/13/10 503750 Refund
Total 45.00
I 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.
Anderson, Donna Allowed 20
24315 Tollgate Rd.
Cicero, IN 46034
In Sure of
45.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -21 503750 4358400 45.00 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
26 -Aug 2010
Signature
45.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund