208420 04/25/2012 VOIDED AND REISSUED CITY OF CARMEL, INDIANA VENDOR: 366178 Page 1 of 1
ONE CIVIC SQUARE MARCIA PENCE CHECK AMOUNT: $46.00
CARMEL, INDIANA 46032 14664 SIR BARTON DRIVE APT H
NOBLESVILLE IN 46060 CHECK NUMBER: 208420
CHECK DATE: 4/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 46.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 809820
Carmel 6 cla Payment Date: 04/10/12
Household 42026
P�a rks &R e C Fe atibh
Monon Community Center Marcia Pence
Carmel IN 46032 APR 1 1 2012 14664 Sir Barton Drive Apt H
Noblesville IN 46060 Cell Ph: (317)642-7243
mpence62 @yahoo.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972 BY.
Pass Details
MEMBERSHIP CHANGE Refund Of 46.00
Pass Holder: Lauren Pence Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC Yth Mthly (M MCYM), #150902 46.00 0.00 46.00 0.00 0.00
Valid Dates: 10/23/2011 to 10/23/2012 (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.
PREVIOUS NET HOUSEHOLD BALANCE 23.00
Processed on 04/10/12 14:31:16 by KLB FEES ADJUSTED ON CHANGED ITEMS 69.00
NET AMOUNT FROM CHANGED ITEMS 69.00=
HH BALANCE APPLIED TO THIS RECEIPT 23.00
TOTAL AMOUNT REFUNDED ,46.00��z
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 46.00 Made By REFUND FINAN With Reference staff error
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.
r f�fiv► /Z 10 12
horized Signature D e A on d n ture Date
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: //201 lcprv. theregistrationsystem .com /en/1033!
1 Z. y35Qo400
0 Ver' 6 ck 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.
Pence, Marcia Terms
14664 Sir Barton Drive Apt H Date Due
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/10/12 809820 Refund 46.00
Total 46.00
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
Pence, Marcia Allowed 20
14664 Sir Barton Drive Apt H
Noblesville, IN 46060
In Sum of
46.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1092 809820 4358400 46.00 i 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
19 -Apr 2012
p i j Yl2r� ci7
Signature
46.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund