206656 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 366053 Page 1 of 1
ONE CIVIC SQUARE POLLY DUKE CHECK AMOUNT: $35.00
CARMEL, INDIANA 46032 11622 FAIRGREEN DRIVE
CARMEL IN 46032 CHECK NUMBER: 206656
CHECK DATE: 2/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 35.00 PARKS DEPARTMENT REFU
GLOBAL REFUND RECEIPT
Receipt 789402
C ame S ,J" a la Payment Date: 02/17112
marks &R.ecreation Household 44413
Monon Community Center Polly Duke Hm Ph: (317)
Carmel IN 46032 11622 Fairgreen Dr
Carmel IN 46032 Cell Ph: (317)918 -7122
pollyduke @sbcglobal.net
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 35.00
Pass Holder: Polly Duke Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Adlt Mthly (M MCAM), #145809 175.00 0.00 175-00 0.00 0.00
Valid Dates: 08/23/2011 to 08/23/2012 (Pass Change)
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 02/17/12 15:09:46 by KLB FEES ADJUSTED ON CHANGED ITEMS 35.00
NET AMOUNT FROM CHANGED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 35.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 35.00 Made By REFUND FINAN With Reference cancelled 1125112
All refunds are subject to State Board of Accounts claim procedure and may take 4- ee to ocess. A check will be
issued. No cash or credit card refunds.
Authorized Signature Date Autho ze ure ale
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:/ 12011cpry .theregistration system. ccmlen /1033! i
FEB 2 1 7012
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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,
Duke, Polly Terms
11622 Fairgreen Dr Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/17112 789402 Refund 35.00
Total 35.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Duke, Polly Allowed 20
11622 Fairgreen Dr
Carmel, IN 46032
In Sum of
35.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO #or INVOICENO. ACCT /TITLE AMOUNT Board Members
Dept
1092 789402 4358400 35.00 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
23 -Feb 2012
Signature
35.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund