HomeMy WebLinkAbout228647 1/28/2014 CITY OF CARMEL, INDIANA VENDOR: 367885 Page 1 of 1
ONE CIVIC SQUARE ERIN NIEMIEC CHECK AMOUNT: $10.00
CARMEL, INDIANA 46032 3531 ROLLING SPRINGS DRIVE
CARMEL IN 46033 CHECK NUMBER: 228647
CHECK DATE: 1/28/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 10 . 00 PARKS DEPARTMENT REFU
GLOBAL REFUND RECEIPT
Receipt# 1191211
Payment Date: 01/09/2014
Household #: 39746 - - r 5 �6cf'iEabon. .
Home Phone: (317)379-7123
JAN 14 2014
ERIN NIEMIEC Monon Community Center
3531 ROLLING SPRINGS DRIVE Carmel IN 46032
CARMEL IN 46033
Phone: (317)848-7275
Fed Tax ID#35-6000972
Pass Details
CANCELLATION
Pass Holder: Erin Niemiec Fees+Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: UnGpFt MCAYSMly (M UGFTMM), #219586 60.00 0.00 60.00 0.00 0.00
Valid Dates: 09/23/2013 to 08/27/2014 (Pass Cancellation)
Cancellation Effective: 01/09/2014
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
nFitness Prog Passes 60.00 1.00 0.00 0.00 60.00
Cancel Reason: not using
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 10.00
Processed on 01/09/14 @ 20:34:33 by HPG FEES CHANGED ON CANCELLED ITEMS(+) 0.00
DISCOUNT APPLIED AGAINST CANCELLED FEES(-) 0.00
SALES TAX CHARGED ON CANCELLED FEES(+) 0.00
NET AMOUNT FROM CANCELLED ITEMS -000
HH BALANCE APPLIED TO THIS RECEIPT(+) 10.00-. _
TOTAL AMOUNT REFUNDED-0 `:. 10 000:.
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 10.00 Made By==>REFUND FINAN With Reference==>
All refunds are subject tq State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
Authorized bAature, Datd LlAuto d S nature 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.
Niemiec, Erin Terms
3531 Rolling Springs Drive Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/9/14 1191211 Refund $ 10.00
Total $ 10.00
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. I�
Niemiec, Erin Allowed 20
3531 Rolling Springs Drive
Carmel, IN 46033
In Sum of$
i
$ 10.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITL AMOUNT
1092 1191211 4358400 $ 10.00 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
21-Jan 2014
Signature
$ 10.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund