223559 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 367505 Page 1 of 1
ONE CIVIC SQUARE SHANNON LUSK CHECK AMOUNT: $76.00
s` �a CARMEL, INDIANA 46032 326 W MAY APPLE
WESTFIELD IN 46074 CHECK NUMBER: 223559
CHECK DATE: 8/27/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 76 . 00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1135857 Carmel @ Clay
Payment Date: 08/16/2013
Household #: 52693 Pa rks&Recreation
Home Phone: (317)846-4983 D�.
Work Phone: (317)844-4948 g � T '-�
AUG 19 2013
BY:
SHANNON LUSK Monon Community Center
326 W. MAY APPLE Carmel IN 46032
WESTFIELD IN 46074
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
MEMBERSHIP CHANGE - Refund Of 76.00
Pass Holder: Shannon Lusk Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: MCorp HH Mty (M CPHHM), #201666 304.00 0.00 304.00 0.00 0.00
Valid Dates: 03/31/2013 to 03/31/2014 (Pass Change)
Auto-Debit Details:
This Pass is scheduled to be billed $76.00 per month 7 times
Fee Details: Fee Description _ Amount Count Discount Sales Tax Total Fee
nCorp Monthly Pass 304.00 1.00 0.00 0.00 304.00
Special Questions: Company: Carmel Clay Schools
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/16/13 @ 11:29:40 by JWH FEES ADJUSTED ON CHANGED ITEMS(+) 76.00-
DISCOUNT APPLIED AGAINST THESE FEES() 0.00
SALES TAX CHARGED ON CHANGED FEES(+) 0.00
NET AMOUNT FROM CHANGED ITEMS 76.00-
TOTAL AMOUNT REFUNDED 76.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 76.00 Made By=_>REFUND FINAN With Reference=_>Staff Error
All refunds are subject to State Board of Accounts procedures and may t key}-6 eks to process. No cash refunds will be
issued. ��
-7-�t l
Authorized Signature Date A thq¢ed gnature bate
Escape Day Passes are non-refundable.
Page# 1 of 1
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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.
Lusk, Shannon Terms
326 W May Apple Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/16/13 1135857 Refund $ 76.00
Total $ 76.00
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.
Lusk, Shannon Allowed 20
326 W May Apple
Westfield, IN 46074
In Sum of$
$ 76.00
ON ACCOUNT OF APPROPRIATION FOR
109 - MCC
PO#or Board Members
INVOICE NO ACCT#/TITLE AMOUNT
Dept#
1092 1135857 4358400 $ 76.00 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
22-Aug 2013
Q&mnuv
Signature
$ 76.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund