213301 10/09/2012 - CITY OF CARMEL, INDIANA VENDOR: 366570 Page 1 of 1
., ONE CIVIC SQUARE LESLIE FROBIG CHECK AMOUNT: $35.00
-1; CARMEL, INDIANA 46032 12580 PEMBROOKE CIRCLE
CARMEL IN 46032 CHECK NUMBER: 213301
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 35 . 00 PARKS DEPARTMENT REFU
GLOBAL REFUND RECEIPT
Receipt# 955436
Carmel e Clay Payment Date: 10/03/12
r ks&A cc eatioh Household#: 42017
Monon Community Center �� '`11��-',T � Leslie Frobig Hm Ph: (317)658-3660
Carmel IN 46032 12580 Pembrooke Circle Wk Ph: (317)873-8050
OCT 0 3 2012 Carmel IN 46032 Ext. 19115
Phone: (317)848-7275 frobig @gmail.com Cell Ph:(317)658-3660
Fed Tax ID#35-6000972 BY:
Pass Details
MEMBERSHIP CHANGE -Refund Of 35.00
Pass Holder: Leslie Frobig Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH Mthly(M MCHHM), #175470 155.00 0.00 155.00 0.00 0.00
Valid Dates: 07/17/2012 to 07/17/2013 (Pass Change)
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10/03/12 @ 10:36:26 by KLB FEES ADJUSTED ON CHANGED ITEMS(+) 35.00-
NET AMOUNT-FROM CHANGED ITEMS 35.00-
TOTAL AMOUNT REFUNDED _. 35.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 35.00 Made By==>REFUND FINAN With Reference==>overcharged;in july
All refunds are subject to State Board of Accounts claim procW ks to process. A check will be
issued. No cash or credit card refunds.
Authorized Signature Date /oD to
Join us at West Park on Saturday, October 6, from 4-9pm, for our Fall Food Festival & Benefit. Local food trucks, restaurants,
and beer/wine vendors compete to be the first ever Fall Food Festival Winner! Try their favorite dishes, relax with the music,
and enjoy a beautiful day at the park with your family. Help children and families participate in department-wide activities;
proceeds will help fund scholarships. $5/person entry fee. There will be an additional cost for food and drink purchases.
Register online at www.carmelclayparks.com.
Escape Day Passes are non-refundable.
10 92 y3�59W0
Page# 1 of 1
I
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.
Frobig, Leslie Terms
12580 Pembrooke Circle Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) . Amount
10/3/12 955436 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
120
Clerk-Treasurer
Voucher No. Warrant No.
Frobig, Leslie Allowed 20
12580 Pembrooke Circle
Carmel, IN 46032
In Sum of$
$ 35.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1092 955436 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
4-Oct 2012
Signature
$ 35.00 _ Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund