HomeMy WebLinkAbout232526 05/13/14 1.�� CITY OF CARMEL, INDIANA VENDOR: 368213
ONE CIVIC SQUARE KASRA HESSARAKI
CHECK AMOUNT: $"""""'14.00'
?�; CARMEL, INDIANA 46032 12994 FLEETWOOD DR N CHECK NUMBER: 232526
.I;
°';�ror(�. CARMEL IN 46032 CHECK DATE: 05/13/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 1240229 14.00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Carmel �} Clay Receipt# 1240229
Payment Date: 04/15/14
1 ; Household#: 41862
forks&Rec�rcatian
IAY 0 8 2014
M 4
Monon Community Center TD-,. Kasra Hessaraki Hm Ph:(317)843-8381
Carmel IN 46032 - ------___ 12994 Fleetwood Dr.N
carmel IN 46032 Cell Ph:(317)402-7935
mhessaraki@yahoo.com
Phone:(317)848-7275
Fed Tax ID#35-6000972
Enrollment Details
Enrollee Name: Kasra Hessraki Fees+Tax Discount Prey Paid Cur Paid Amount Due
Activity Number: 343107-22 Learn to Swim Level 45.00 0.00 0.00 45.00 0.00
Enrollment Date: 04/15/2014' (Enrolled-Transfer from 343107-13(Learn to Swim Level))
Class Location: Indoor Lap Pool 6 Class Dates: 04/15/2014 to 04/29/2014
Monon Community Cntr 4:OOP to 4:55P
Tu
Carmel, IN 46032 Scheduled Sessions: 3
(317)848-7275
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 04/15/14 @ 14:44:41 by KTOURNEY FEES ADJUSTED ON CHANGED ITEMS(+) 14.00-
f0'('3fty' -from �5r1 CIG '1 D y5 NET AMOUNT FROM CHANGED ITEMS 14.00-
[A Le- TOTAL AMOUNT REFUNDED 14.00
�7 NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 14.00 Made By=_>REFUND FINAN With Reference=_>
Payment of=_> 45.00 Made By=_> Activity Registration Credit Balance
All refunds are subject to State Board of Accounts procedures and may take 4-6 eks to ocess. No cash refunds will be
issued.
� 5h 114
AuthorizedSignature Date uth z nat e D e
g
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.
Hessaraki, Kasra Terms
12994 Fleetwood Dr. N Date Due
Carmel, IN 46032
Invoice Invoice Description .
Date Number (or note attached invoice(s) or bill(s)) Amount
4/15/14 1240229 Refund $ 14.00
Total $ 14.00
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.
Hessaraki, Kasra Allowed 20
12994 Fleetwood Dr. N
Carmel, IN 46032
In Sum of$
$ 14.00 �.
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
I
I
PO#or ( Board Members
Dept# INVOICE NO. ACCT#/TITLE AMOUNT i
1096-10 1240229 4358400 $ 14.00 Ilhereby 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
8-May 2014
Signature
$ 14.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund