216027 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 366810 Page 1 of 1
ONE CIVIC SQUARE TAMMY FIFE-TROUT
4 0 CHECK AMOUNT: $95.00
CARMEL, INDIANA 46032 8620 DRIFTWOOD DRIVE
INDIANAPOLIS IN 46240 CHECK NUMBER: 216027
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 95 . 00 PARKS DEPARTMENT REFU
*' GLOBAL REFUND RECEIPT
7
Receipt# 984672
r , I y Payment Date: 12/19/12
Household#: 47763
Parks&Recreation
Monon Community Center Tammy Fife-Trout Hm Ph: (317) -
Carmel IN 46032 8620 Driftwood Drive
Indianapolis IN 46240 Cell Ph:(317)581-9388
Phone: (317)848-7275 ltammy@comcast.net
Fed Tax ID#35-6000972
Pass Details
CANCELLATION - Refund Of 95.00
Pass Holder: Tammy Fife-Trout Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH Mthly (M MCHHM), #167642 665.00 0.00 0.00 665.00 0.00
Valid Dates: 05/06/2012 to 05/06/2013 (Pass Cancellation)
Cancellation Effective: 12/19/2012
Cancel Reason: cancellation phone staff error 12/2/12
CANCELLATION
Pass Holder: Greg Trout Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH+(M MCHH+), #167643 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/06/2012 to 05/06/2013 (Pass Cancellation)
Cancellation Effective: 12/19/2012
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: cancellation phone staff error 12/2/12
CANCELLATION
Pass Holder: Morgan Fife-Trout Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH+(M MCHH+), #167644 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/06/2012 to 05/06/2013 (Pass Cancellation)
Cancellation Effective: 12/19/2012
Cancel Reason: cancellation phone staff error 12/2/12
CANCELLATION
Pass Holder: Joseph Fife-Trout Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH+ (M MCHH+), #167645 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/06/2012 to 05/06/2013 (Pass Cancellation)
Cancellation Effective: 12/19/2012
Cancel Reason: cancellation phone staff error 12/2/12
CANCELLATION
Pass Holder: Jameshia Taylor Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH+(M MCHH+),#167646 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/06/2012 to 05/06/2013 (Pass Cancellation)
Cancellation Effective: 12/19/2012
Cancel Reason: cancellation phone staff error 12/2/12
Page# 1 of 2
� h
GLOBAL REFUND RECEIPT
Carmel � �I�/ Receipt# 984672
Parks&Recreation Payment Date: 12/19/2012
Household #: 47763
CANCELLATION
Pass Holder: AJ Lewslaughter Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH+ (M MCHH+),#167647 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/06/2012 to 05/06/2013 (Pass Cancellation)
Cancellation Effective: 12/19/_2001122
Cancel Reason: atll ion phone staff error 12/2/12
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 12/19/12 @ 12:47:46 by TLP FEES CHANGED ON CANCELLED ITEMS(+) 760.00-
SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 665.00-
NET:AMOUNT FROMrCANCELLED ITEMS` : ';,=' 95:00••
Q >=TOTAL YAMOUNT�REF._UNDEDa:,:`�f," • ;-: 95:00`+
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 95.00 Made By==> FINAN With Reference==>
All refunds are subject to oar of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
4;�Z / _? 1 !G 12-
Au on d Signa Date Authonz Sin lure Dale
Escape Day Passes are non-refundable.
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.
Fife-Trout, Tammy Terms
8620 Driftwood Drive Date Due
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/19/12 984672 Refund $ 95.00
_'Total $ 95.00
l 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.
f
.i
Fife-Trout, Tammy Allowed 20
8620 Driftwood Drive
Indianapolis, IN 46240 i
-Iri Sum of$
$ 95.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1092 984672 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
3-Jan 2013
Signature
$ 95.00 Accounts Payable_Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund