189905 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 364700 Page 1 of 1
ONE CIVIC SQUARE MICHAEL MENDEZ CHECK AMOUNT: $36.25
CARMEL, INDIANA 46032 6180 WASHINGTON BLVD
INDIANAPOLIS IN 46220 CHECK NUMBER: 189905
hpq c
CHECK DATE: 9114/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 36.25 PARKS DEPARTMENT REFU
GLOBAL REFUND RECEIPT
Receipt 512684
Payment Date: 08/27110
Household 20057
Monon Community Center AUG 3 O 2010 Michael Mendez Hm Ph: (317)709 -8999
Carmel IN 46032 6180 Washington Blvd.
Indianapolis IN 46220 Cell Ph:
Phone: (317)848 -7275 BY
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION
Pass Holder: Michael Mendez Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Seas AQ Adult (SAQAR) #68565 63.75 0.00 0.00 63.75 0.00
Valid Dates: 05129/2010 to 09/06/2010 Pass Cancellation) C�
U`�`; 1 IYtD�S�1�D
Cancel Reason: repeated complaints; lap pool cloudy
CANCELLATION Refund Of 36.25
Pass Holder: Lydia Mendez Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type. Seas AQ Youth (SAQYR), #68566 45.00 0.00 0.00 45.00 0.00
Valid Dates: 05/29/2010 to 09/06/2010 Pass Cancellation)
Pass Comments: Children must be age 11 or older to utilize the pools and /or gymnasium unaccompanied by an
adult. &D
h)o /5- rrmo
Cancel Reason: repeated complaints; lap pool cloudy
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/27/10 16:07:43 by AMH FEES CHANGED ON CANCELLED ITEMS 145.00
SURCHARGE APPLIED AGAINST CANCELLED FEES O 108J5-
NET'AMOUNT'FROM CANCELLED ITEMS',36x25
TOTAL;:AMOUNT 36.25!'
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 36.25 Made By REFUND FINAN With Reference guest complaint
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.
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Authorized Signature Dat Authorized Signature Date
it C) �a +35 1 LOO
Don't forget to pre- register for St.Vincent Tour de Carmel on or before Friday, August 27 to receive your goodie bag and
T -shirt. Visit www.carmelclayparks.com for more information or https: /rec.themononcenter.com/ to register!
If you have already registered for the event, you may pick up your goodie bag at the MCC East Building on September 7 from
5 -8pm, September 8 from 9am -1 pm, or September 9 from 5 -8pm.
Page 1
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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.
Mendez, Michael Terms
6180 Washington Blvd Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8127/10 512684 Refund 36.25
Total 36.25
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
Mendez, Michael Allowed 20
6180 Washington Blvd
Indianapolis, IN 46220
In Sum of
36.25
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1092 512684 4358400 36.25 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
9 -Sep 2010
VIk
Signature
36.25 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund