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207262 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 366086 Page 1 of 1 ONE CIVIC SQUARE DENNIS WHITAKER tI' CHECK AMOUNT: $190.00 CARMEL, INDIANA 46032 5159 WARBLER WAY SOUTH ;o� CARMEL IN 46033 CHECK NUMBER: 207262 CHECK DATE: 3/13/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1092 4358400 190.00 PARKS DEPARTMENT REFU GLOBAL REFUND RECEIPT Receipt 794286 ar' nel: a Cl Payment Date: 03/03/12 Household 14901 rkS &k(E cre tJo Monon Community Center Dennis Whitaker Hm Ph: (317)566 -8415 Carmel IN 46032 5159 Warbler Way S Wk Ph: (317)849 -7900 Carmel IN 46033 Cell Ph: (317)440-1078 kwhitaker @indy.rr.com Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Pass Details CANCELLATION Refund Of 190.00 Pass Holder: Dennis Whitaker Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH Mthly (M MCHHM), #139276 665.00 0.00 0.00 665.00 0.00 Valid Dates: 06/01/2011 to 06/01/2012 (Pass Cancellation) Cancel Reason: Non -use, refund is for cancellation received in January that was not cancelled. CANCELLATION Pass Holder: Madeline Whitaker Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH+ (M MCHH #139277 0.00 0.00 0.00 0.00 0.00 Valid Dates: 06/01/2011 to 06/01/2012 (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: Non -use, refund is for cancellation received in January that was not cancelled. CANCELLATION Pass Holder. Jessica Whitaker Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH+ (M MCHH #139278 0.00 0.00 0.00 0.00 0.00 Valid Dates: 06/01/2011 to 06/01/2012 (Pass Cancellation) Cancel Reason: Non -use, refund is for cancellation received in January that was not cancelled. CANCELLATION Pass Holder: Karen Whitaker Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH+ (M MCHH #139279 0.00 0.00 0.00 0.00 0.00 Valid Dates: 06/01/2011 to 06/01/2012 (Pass Cancellation) Cancel Reason: Non -use, refund is for cancellation received in January that was not cancelled. CANCELLATION Pass Holder: Sally Whitaker Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH+ (M MCHH #139280 0.00 0.00 0.00 0.00 0.00 Valid Dates: 06/01/2011 to 06/01/2012 (Pass Cancellation) Cancel Reason: Non -use, refund is for cancellation received in January that was not cancelled. MAR 0 5 2012 6 07: Page 1 o12 GLOBAL REFUND RECEIPT r p 1 Receipt 794286 arks&Recreat.ion Payment Date: 03/03/2012 Household 14901 PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 03/03/12 14:43:26 by KLB FEES CHANGED ON CANCELLED ITEMS 855.00 SURCHARGE APPLIED AGAINST CANCELLED FEES O 665.00 NET AMOUNT FROM CANCELLED ITEMS 190.0© TOTAL AMOUNT,REFUNDED 190.00 NEW NET HOUSEHOLD BALANCE 0.00 Refund of 190.00 Made By REFUND FINAN With Reference refund All refunds are subject to State Board of Accounts claim procedure and may tak eek to process. A check will be issued. No cash or credit card refunds. 33 Authorized Signature Date Aut or ed Signatu ate 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: /2011cprv. theregistrationsystem .com /en/1033! a ia�Z.y3s�yoo Page 2 of 2 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. Whitaker, Dennis Terms 5159 Warbler Way S Date Due Carmel, IN 46033 Invoice Invoice Description Date Number or note attached invoice(s) or bill(s)) Amount 190.00 313112 794286 'Refund Total 190.00 cordance I hereby certify that the attached invoice {s), or bill {s) is (are) true and correct and I have audited same in ac with Ic 5- 11- 10 -1.6 20_ Clerk- Treasurer Voucher No. Warrant No. Whitaker, Dennis Allowed 20 5159 Warbler Way S Carmel, IN 46033 In Sum of 190.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1092 794286 4358400 190.00 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 8 -Mar 2012 Signature I 190.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund