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Home My WebLink About213898 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 366649 Page 1 of 1 ONE CIVIC SQUARE TIMOTHY DINES CHECK AMOUNT: $95.00 CARMEL, INDIANA 46032 18201 EMMA CIRCLE WESTFIELD IN 46062 CHECK NUMBER: 213898 CHECK DATE: 10/23/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1092 4358400 95 . 00 PARKS DEPARTMENT REFU GLOBAL REFUND RECEIPT Receipt# 962902 Carmel 1D Clad Payment Date: 10/19/12 Parks&Recreatioh R.E CETX7ED Household M 38409 OCT 19 2012 Monon Community Center $Y: Timothy Dines Hm Ph: (317)867-3293 Carmel IN 46032 18201 Emma Circle Wk Ph: (765)675-5201 Westfield IN 46062 Cell Ph:(765)437-1402 tdines @msn.com Phone: (317)848-7275 Fed Tax ID#35-6000972 Pass Details CANCELLATION -Refund Of 95.00 Pass Holder: Timothy Dines Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH Mthly(M MCHHM),#126300 855.00 0.00 0.00 855.00 0.00 Valid Dates: 01104/2012 to 01103/2013 (Pass Cancellation) Cancellation Effective: 10/19/2012 CANCELLATION Pass Holder: Kathryn Dines Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH+ (M MCHH+), #126301 0.00 0.00 0.00 0.00 0.00 Valid Dates: 01/04/2012 to 01/03/2013 (Pass Cancellation) Cancellation Effective: 1011912012 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. CANCELLATION Pass Holder: Jacob Dines Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH+ (M MCHH+),#126302 0.00 0.00 0.00 0.00 0.00 Valid Dates: 01/04/2012 to 01/03/2013 (Pass Cancellation) Cancellation Effective: 10/19/2012 CANCELLATION Pass Holder: Zachary Dines Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH+ (M MCHH+),#126303 0.00 0.00 0.00 0.00 0.00 Valid Dates: 01/04/2012 to 01/03/2013 (Pass Cancellation) Cancellation Effective: 10/19/2012 CANCELLATION Pass Holder: Glace Dines Fees+Tax Discount Prev Paid Cur Paid Amount Due Pass Type: MC HH+ (M MCHH+), #126304 0.00 0.00 0.00 0.00 0.00 Valid Dates: 01/04/2012 to 01/03/2013 (Pass Cancellation) Cancellation Effective: 10/19/2012 Page# 1 of 2 '�° GLOBAL REFUND RECEIPT Carmel -+�` Receipt# 962902 Parks&Recreation Payment Date: 10/19/2012 Household#: 38409 PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 10/19/12 @ 11:33:07 by KLB FEES CHANGED ON CANCELLED ITEMS(+) 950.00- SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 855.00- NET AMOUNT'FROM CANCELLED.ITEMS TOTAL AMOUNT REFUNDED 95.00 NEW NET HOUSEHOLD BALANCE 0.00 Refund of=_> 95.00 Made By==>REFUND FINAN With Reference==>cancelled 10/4/12 All refunds are subject to State Board of Accounts claim procedure and may t ke - eeks o process. A check will be issued. No cash or credit card refunds. 10/19 IZ Authorized Signature Date Au t on d Si nat a date Ready for a Family Pool Challenge in Indoor Aquatics?Then pull your swimsuit out from the closet, put on your thinking or swimming cap, and prepare for an evening of excitement, challenge, and family-friendly competition. Join us on Friday, November 2, from 6-9pm, as we build cardboard boats to race and compete in fun relays and games! Finish with open swim while enjoying the waterslides and more with your family. Don't miss out on this perfect family team building night that you'll remember forever! $10/family. Register online at www.carmelclayparks.com (activity#229003-01). Escape Day Passes are non-refundable. JO 92. 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. Dines, Timothy Terms 18201 Emma Circle Date Due Westfield, IN 46062 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 10/19/12 962902 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 20_ Clerk-Treasurer Voucher No. Warrant No. Dines, Timothy Allowed 20 18201 Emma Circle Westfield, IN 46062 In Sum of$ $ 95.00 ON ACCOUNT OF APPROPRIATION FOR 109 -Monon Center PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1092 962902 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 19-Oct 2012 4jChh11nrYW-,7,, Signature $ 95.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund