HomeMy WebLinkAbout230627 03/26/14 CITY OF CARMEL, INDIANA VENDOR: 368084
ONE CIVIC SQUARE RICHARD SURBER CHECK AMOUNT: $********10.00*
. CARMEL, INDIANA 46032 11445 MONON FARMS LANE CHECK NUMBER: 230627
CARMEL IN 46032 CHECK DATE: 03/26/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 1219679 10.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt# 1219679
Carmel @ Clay Payment Date: 03/07/14
Clay
#: 14000
Forks&Recreation
Monon Community Center Richard Surber Hm Ph: (317)818-9293
Carmel IN 46032 11445 Monon Farms Lane Wk Ph: (317) -
Carmel IN 46032 Cell Ph:(317)431-8247
Phone: (317)848-7275 surberl@yahoo.com
Fed Tax ID#35-6000972
Enrollment Details
CANCELLATION -Refund Of 10.00
Enrollee Name: Lois Surber Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 347033-02 Financial Planning 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 02/18/2014 (Cancelled)
Primary Instructor: Joel Harris
Class Location: Multipurpose Room B Class Dates: 03/13/2014 to 03/13/2014
Monon Community Cntr 6:OOP to 8:OOP
Th
Carmel, IN 46032 Scheduled Sessions: 1
(317)848-7275
Cancel Reason: low enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 03/07/14 @ 14:08:06 by MML FEES CHANGED ON CANCELLED ITEMS(+) 10.00-
NET AMOUNT FROM CANCELLED ITEMS 10.00-
TOTAL AMOUNT REFUNDED 10.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 10.00 Made By=_>REFUND FINAN With Reference=_>low enrollment
All refunds are subject to State Board of Accounts procedures and may take -6 week to process. No cash refunds will be
issued.
71
Authorized Signature Date Auth zed ignature Date
61'?G- Sd. �} 6e"
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.
Surber, Richard Terms
11445 Monon Farms Lane Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/7/14 1219679 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
120
Clerk-Treasurer
Voucher No. Warrant No.
Surber, Richard I Allowed 20
11445 Monon Farms Lane
Carmel, IN 46032
In Sum of$
$ 10.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-50 1219679 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
20-Mar 2014
Signature
$ 10.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund