216248 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: T362390 Page 1 of 1
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ONE CIVIC SQUARE MICHELLE FOLEY
CARMEL, INDIANA 46032 89 WEST QUAIL WOOD LANE CHECK AMOUNT: $95.00
' WESTFIELD IN 46074
CHECK NUMBER: 216248
CHECK DATE: 119/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 95 . 00 PARKS DEPARTMENT REFU
GLOBAL REFUND RECEIPT
Receipt# 984876
. r� hd 6 `':,� Payment Date: 12/20/12
Household #: 25537
- rl sA 66r it Ac'n:
E
Monon Community Center DEC 2 12012 Michelle Foley Hm Ph: (317)896-3897
Carmel IN 46032 89 West Quail Wood Lane Wk Ph: (317)218-2197
Westfield IN 46074 Cell Ph:(317)691-9489
Phone: (317)848-7275
$Y:_ fbleymicheller @hotmail.com
-
Fed Tax ID#35-6000972
Pass Details
CANCELLATION -Refund Of 95.00
Pass Holder: Michelle Foley Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MC HH Mthly (M MCHHM), #160093 950.00 0.00 0.00 950.00 0.00
Valid Dates: 02/09/2012 to 02/09/2013 (Pass Cancellation)
Cancellation Effective: 12/20/2012
Cancel Reason: Everyone was cancelled in the household on the day cancellation was submitted except Michelle, so they were
charged inadvertantly for December.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 12/20/12 @ 14:37:24 by KLB FEES CHANGED ON CANCELLED ITEMS(+) 1,045.00-
SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 950.00-
NET AMOU NT.FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED. 95.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 95.00 Made By==>REFUND FINAN With Reference==>staff error
All refunds are subject to State Board of Accounts procedures and may take 4- s to process. No cash refunds will be
issued.
l2. ac, I Z
Authorized Signature Date t rized Si na re date
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.
Foley, Michelle Terms
89 West Quail Wood Lane Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/20/12 984876 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.
Foley, Michelle Allowed 20
89 West Quail Wood Lane
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 984876 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