218784 04/09/2013 CITY OF CARMEL, INDIANA VENDOR: 358408 Page 1 of 1
ONE CIVIC SQUARE TIFFANY BUCKINGHAM
CHECK AMOUNT: $85.00
CARMEL, INDIANA 46032 5057E 71ST STREET
INDIANAPOLIS IN 46205 CHECK NUMBER: 218784
CHECK DATE: 4/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 85 . 00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1030106
Carmel s Clay Payment Date: 04/01/13
Household #: 15708
rks&Recreation
4
Monon Community Center 1 APR 0 2 2013 Tiffany Buckingham Hm Ph: (513)505-0298
Carmel IN 46032 5057 E 71st Street Wk Ph: (317)698-6579
Indianapolis IN 46220 Cell Ph:(513)505-0298
tbuckingham @carmelclayparks.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION
Pass Holder: Tiffany Buckingham Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Corp UnIGrpFit(CORP UGF), #194156 40.00 0.00 40.00 0.00 0.00
Valid Dates: 01/22/2013 to 10/24/2013 (Pass Cancellation)
Cancellation Effective: 04/01/2013
Cancel Reason: Not using
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 85.00
Processed on 04/01/13 @ 11:06:03 by MNS FEES CHANGED ON CANCELLED ITEMS(+) 0.00
NET AMOUNT FROM CANCELLED ITEMS 0.00
HH BALANCE APPLIED TO THIS RECEIPT(+) 85.00-
TOTAL AMOUNT REFUNDED 85.00. .
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 85.00 Made By=_>REFUND FINAN With Reference=_>
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
A,
Authorized Signature Date xutyon7rignature ate
Escape Day Passes are non-refundable.
1 091.435$1400
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.
Terms
Buckingham, Tiffany
Date Due
5057 E 71 st Street
Indianapolis, IN 46220
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
$ 85.00
411113 1030106 Refund
Total $ 85.00
I 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,
Buckingham, Tiffany Allowed 20
5057 E 71st Street
Indianapolis, IN 46220
In Sum of$
$ 85.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITLE AMOUNT
1092 1030106 4358400 $ 85.00 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-Apr 2013
Signature
$ 85.00 _ Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund