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Home My WebLink About204813 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 365877 Page 1 of 1 f ONE CIVIC SQUARE KAREN GRAY CARMEL., INDIANA 46032 1311 ORCHARD PARK N DR CHECK AMOUNT: $228.00 INDIANAPOLIS IN 46280 CHECK NUMBER: 204813 CHECK DATE: 12/20/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1092 4358400 228.00 REFUNDS AWARDS INDE GLOBAL REFUND RECEIPT Receipt 759198 arm I o Cloy Payment Date: 12/14/11 I arks &[recreation Household 24519 x rit i,z'i a j Monon Community Center Q ry Op Karen Gray Hm Ph: (317)658 -6801 Carmel IN 46032 1311 Orchard Park N. Dr. f ?h 5 Indianapolis IN 46280 Cell Ph: (317)658-6801 klgray2 @gmail.com Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Mr Pass Details CANCELLATION Refund Of 228.00 Pass Holder: Caitlin Gray Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: AgGy Yth Mthly (XM AGYM), #107890 133.00 0.00 0.00 133.00 0.00 Valid Dates: 05/28/2010 to 01/14/2012 (Pass Cancellation) Pass Comments: Children must be age 11 or older to utilize the pools and /or gymnasium unaccompanied by an adult. Cancel Reason: not using and has 2 passes for the last 12 months. error in pass transfer on original 10/16/10 process CANCELLATION Pass Holder: Caitlin Gray Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC Yth Mthly (M MCYM), #120228 69.00 0.00 69.00 0.00 0.00 Valid Dates: 09/26/2011 to 10/16/2012 (Pass Cancellation) Pass Comments: Children must be age 11 or older to utilize the pools and/or gymnasium unaccompanied by an adult. Children ages 11 -13 may use Fitness Center, but must be under adullt supervision. Children must be age 14+ to utilize the Fitness Center without adult supervision. Cancel Reason: not using PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 12114/11 05:24:31 by TLP FEES CHANGED ON CANCELLED ITEMS 361.00 G�� Il SURCHARGE APPLIED AGAINST CANCELLED FEES 133.00 �Y C) NET AMOUNT FROM CANCELLED ITEMS 228.00 S` I TOTAL AMOUNT REFUNDED 228.00 NEW NET HOUSEHOLD BALANCE 0.00 Refund of 228.00 Made By REFUND FINAN With Reference All refunds are subject to late Board of Accounts claim procedure and may to 4 -6 weeks to process. A check will be issued. No cash or credit and refund 145h Authorized Signature Date oriz b atl Volunteer with Us! Volunteers are the foundation of Carmel Clay Parks Recreation and we need your help! We are currently seeking volunteers for special events, adaptive programs, parks and greenways, and Extended School Enrichment. If interested, please call Dana at 317.843.3868 or register online at https:// 201lcpry .theregistrationsystem.com /en /1033! Page 1 of 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. Gray, Karen Terms 1311 Orchard Park N Dr. Date Due Indianapolis, IN 46280 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/14111 759198 Refund 228.00 Total 228.00 1 hereby certify that the attached invoice(s), or bi11(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. Gray, Karen Allowed 20 1311 Orchard Park N Dr. Indianapolis, IN 46280 In Sum of 228.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1092 759198 4358400 228.00 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 15 -Dec 2011 Signature 228.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund