213304 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 366575 Page 1 of 1
0 ONE CIVIC SQUARE LATESHA MAPLES
CARMEL, INDIANA 46032 252 COATSVILLE DRIVE CHECK AMOUNT: $95.00
WESTFIELD IN 46074 CHECK NUMBER: 213304
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 95 . 00 PARKS DEPARTMENT REFU
GLOBAL REFUND RECEIPT
r�y Tom-
� ' T" �,T Payment 953857
Pa ment Date: 09/27/12
Nrks&Recreation
SAP 2 '012 Household#: 32281
Monon Community Center ZV L Z dls Latesha Newton
Carmel IN 46032 252 Coatsville Dr.
�-�r Y`,� /� Westfield IN 46074 Cell Ph:(317)777-9866
�..kLeJll'i,_- "f: ".-)a 'rJ michaelnewton03 @gmail.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION -Refund Of 95.00
Pass Holder: Ny,luan Maples Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH Mthly(M MCHHM),#176072 0.00 0.00 0.00 0.00 0.00
Valid Dates: 08/06/2012 to 08/06/2013 (Pass Cancellation)
Cancellation Effective: 09/2712012
Cancel Reason: Cancelled pass the day he signed up because he did not realize KZ doesn't take kids under the age of 6
months. Auto withdrawal never stopped, approved by Susan Beaurain.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 09/27/12 @ 08:59:48 by KLB FEES CHANGED ON CANCELLED ITEMS(+) 95.00-
NET AMOUNT FROM CANCELLED ITEMS 95:00-
TOTAL AMOUNT REFUNDED 9500
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 95.00 Made By==>REFUND FINAN With Reference==>error
All refunds are subject to State Board of Accounts claim procedIM& 6 weeks to process. A check will be
issued. No cash or credit card refunds.
2
Authorized Sign ature Date _Auth)fZ6ig ture Dat
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.
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.
Newton, Latesha Terms
252 Coatsville Dr. Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9127/12 953857 Refund $ 95.00
Total $ 95.00
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.
Newton, Latesha Allowed 20
252 Coatsville Dr.
Westfield, IN 46074
In Sum of$
$ 95.00
ON ACCOUNT OF APPROPRIATION FOR _
109 - Monon Center
PO#or INVOICE NO. ACCT#!TITLE AMOUNT Board Members
Dept#
1092 953857 4358400 $ 95.00 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
$ 95.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund