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Home My WebLink About233143 05/29/14 W.��q �% CITY OF CARMEL, INDIANA VENDOR: 368258 r`' ONE CIVIC SQUARE RYAN KURTZ CHECK AMOUNT: $*****1,092.00* CARMEL, INDIANA 46032 3124 WINDY KNOLL LANE CHECK NUMBER: 233143 9M(TON.�:a, WESTFIELD IN 46074 CHECK DATE: 05/29/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1082 4358400 1,092.00 REFUNDS AWARDS & INDE ACTIVITY REFUND RECEIPT Receipt# 1253991 Payment Date: 05/20/14 Household#: 36583 Parks Ae"creation :C _1C R-71,7ED Monon Community Center MAY 2 12014 Ryan Kurtz . Hm Ph: 317)733=4642 Carmel IN 46032 ,I 3124 Windy Knoll Ln Wk Ph: 317)707-2726 `�;_- 1® Westfield IN 46074 Cell Ph:(317)372-3650 –-- rkurtz17@yahoo.com Phone: (317)848-7275 Fed Tax ID#35-6000972 Enrollment Details CANCELLATION Enrollee Name: Brayden Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476008-01 Lead the Way 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Class-Location: Multipurpose Room C Class Dates: 06/021201.4 to 06/06/2014 Monon Community Cntr 8:OOA to 5:30P M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: 5 (317)848-7275 Skip Days 07/04/2013, 07/05/2013 Cancel Reason: change in plans-moving out of state CANCELLATION -Refund.Of 77.00 Enrollee Name: Brayden Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476008-02 Lead the Way 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 05/01/2014 (Cancelled) . Class Location: Multipurpose Room C Class Dates: 06/09/2014 to 06/13/2014 Monon Community Cntr 8:OOA to 5:30P M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: 5 (317)848-7275 Cancel Reason: change in plans-moving out of state CANCELLATION -Refund Of 87.50 Enrollee Name: Brayden Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476008-04 Lead the Way 7.00 0.00 0.00 - -7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Class Location: Multipurpose Room C Class Dates: 06/23/2014 to 06/27/2014 Monon Community Cntr 8:OOA to 5:30P M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: 5 (317)848-7275 Cancel Reason: change in plans-moving out of state CANCELLATION - Refund Of 70.00 Enrollee Name: Brayden Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476008-05 Lead the Way 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Page# 1 of 5 ACTIVITY REFUND RECEIPT irl c1py Receipt# 1253991 C"k &Repc "e t dh Payment Date: 05/20/2014 Household#: 36583 Class Location: Multipurpose Room C Class Dates: 06/30/2014 to 07/03/2014 Monon Community Cntr 8:OOA to 5:30P M,Tu,W,Th Carmel, IN 46032 Scheduled Sessions: 4 (317)848-7275 Cancel Reason: change in plans-moving out of state CANCELLATION -Refund Of 87.50 Enrollee Name: Brayden Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476008-06 Lead the Way 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 02/04/2014 (Cancelled) Class Location: Multipurpose Room C Class Dates: 07/07/2014 to 07/11/2014 - Monon Community Cntr- -- " &OOA to 5:30P M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: 5 (317)848-7275 Cancel Reason: change in plans-moving out of state CANCELLATION -Refund Of 87.50 Enrollee Name: Brayden Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476008-07 Lead the Way 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Class Location: Multipurpose Room C Class Dates: 07/14/2014 to 07/18/2014 Monon Community Cntr 8:OOA to 5:30P M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: 5 (317)848-7275 Cancel Reason: change in plans-moving out of state CANCELLATION - Refund Of 87.50 Enrollee Name: Brayden Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476008-08 Lead the Way 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Class Location: -Multipurpose Room C- Class Dates: 07%21/2014 to 07/25/2014 Monon Community Cntr 8:OOA to 5:30P M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: ' 5 (317)848-7275 Cancel Reason: change in plans-moving out of state CANCELLATION -Refund Of 87.50 Enrollee Name: Addison Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476001-11 Play On 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Page# 2 of 5 ACTIVITY REFUND RECEIPT Cees/ * Receipt# 1253991 Parks& ear e i n Payment Date: 05/20/2014 -Household#: 36583 Class Location: Creekside Middle Sch Class Dates: 06/02/2014.to 06/06/2014 Creekside Middle Sch 7:OOA to. 6:OOP 3525 W. 126th Street M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: 5 (317)848-7275 Skip Days 07/04/2013 Cancel Reason: change in plans-moving out of state CANCELLATION -Refund Of 87.50 Enrollee Name: Addison Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476001-12 .Play On 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Class Location: Creekside Middle Sch Class Dates: 06/09/2014 to 06/13/2014 Creekside Middle Sch 7:OOA to 6:OOP 3525 W. 126th Street M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: 5 (317)848-7275 Cancel Reason: change in plans-moving out of state CANCELLATION -Refund Of 87.50 Enrollee Name: Addison Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476001-14 Play.On 7.00 _ 0.00 0.00 7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Class Location: Creekside Middle Sch Class Dates: 06/23/2014 to 06/27/2014 Creekside Middle Sch 7:OOA-to 6:OOP 3525 W. 126th Street M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: 5 (317)848-7275 Cancel Reason: change in plans-moving out of state CANCELLATION -Refund Of 70.00 Enrollee Name: Addison Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476001-15 Play On 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Class Location: Creekside Middle Sch Class Dates: 06/30/2014 to 07/03/2014 Creekside Middle Sch 7:OOA to 6:OOP 3525 W. 126th Street M,Tu,W_ ,Th Carmel, IN 46032 Scheduled Sessions: 4 (317)848-7275 .. Skip Days 07/04/2013 Cancel Reason: change in plans-moving out of state CANCELLATION -Refund Of 87.50 Enrollee Name: Addison Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476001-17 Play On 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Page# 3 of 5 - ACTIVITY REFUND RECEIPT :.Of y C Ca. Receipt# 1253991 r �&Recma idn. - Payment Date: 05/20/2014 7�i Household#: 36583 MAY Class Location: Creekside Middle Sch Class ate` 07/14/2014 to 07/18/2014 Creekside Middle Sch 7:OOA to 6:OOP 3525 W. 126th Street M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: 5 (317)848-7275 Cancel Reason: change in plans-moving out of state CANCELLATION -Refund Of 87.50 Enrollee Name: Addison Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476001-18 Play On 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Class Location: Creekside Middle Sch Class Dates: 07/21/2014 to 07/25/2014 --- Creekside Middle Sch; "7:00Afo 6.00P . _ 3525 W. 126th Street M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: 5 (317)848-7275 Cancel Reason: change in plans-moving out of state CANCELLATION -Refund Of 87.50 Enrollee Name: Addison Kurtz Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 476001-19 Play On 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 01/21/2014 (Cancelled) Class Location: Creekside Middle Sch Class Dates: 07/28/2014 to 08/01/2014 Creekside Middle Sch 7:OOA to 6:OOP 3525 W. 126th Street M,Tu,W,Th,F Carmel, IN 46032 Scheduled Sessions: 5. (317)848-7275 Cancel Reason: change in plans-moving out of state PREVIOUS NET HOUSEHOLD BALANCE 1,190.00 Processed on 05/20/14 @ 12:19:05 by BJJ FEES CHANGED ON CANCELLED ITEMS(+) 2,380.00- SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 98.00- NET.•AMOUNT•FROM,CANCELLED ITEMS- 7;282:00" HH BALANCE APPLIED TO THIS RECEIPT(+) 1,190.00 TOTALAMOUNT°REFUNDED. " NEW NET HOUSEHOLD BALANCE 0.00 Refund of=_> 1,092.00 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. Page# 4 of 5 ACTIVITY REFUND RECEIPT � �1-1 C + j�j'J Receipt# 1253991 Nr ecr ioh Payment Date: 05/20/2014 MAY 2 .1 2014 Household#: 36583 Authori Signature Date Authorized Signature Date Escape Day Passes are non-refundable. T 1 0 � I Page# 5 of 5 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. Kurtz, Ryan Terms 3124 Windy Knoll Ln Date Due Westfield, IN 46074 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/20/14 1253991 Refund $ 546.00 5/20/14 1253991 Refund $ 546.00 Total $ 1,092.00 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. Kurtz, Ryan Alllowed 20 3124 Windy Knoll Ln Westfield, IN 46074 In Sum of$ $ 1,092.00 ON ACCOUNT OF APPROPRIATION FOR 1 108 -ESE PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1082-11 1253991 4358400 $ 546.00 1 hereby certify that the attached invoice(s), or 1082-13 1253991 4358400 $ 546.00 biil(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-May 2014 Signature . $ 1,092.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund I