HomeMy WebLinkAbout233869 06/18/14 a a.4�A,y
J`� '� CITY OF CARMEL, INDIANA VENDOR: 368311 ;*} *i
ONE CIVIC SQUARE CHRISTINA STARACE CHECK AMOUNT: $ 168.00
?�; CARMEL, INDIANA 46032 11554 BELMONT CT CHECK NUMBER: 233869
°j,�raa�. CARMEL IN 46032 CHECK DATE: 06/18/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 1269751 168.00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 1269751
1 Payment Date: 06/09/14
Household#: 55348
irks& c� t n
Monon CommunityCenter
Christina Starace Hm Ph: (317)946-2414
Carmel IN 46032 11554 Belmont Ct. Wk Ph: (317)234-2524
Carmel IN 46032 Cell Ph:(317)946-2414
Phone: (317)848-7275
staracewilliams@gmail.com
Fed Tax ID#35-6000972
Enrollment Details
CANCELLATION -Refund Of 168.00
Enrollee Name: Sophia Williams Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476001-16 Play On 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 03/04/2014 (Cancelled)
Class Location: Creekside Middle Sch Class Dates: 07/07/2014 to 07/11/2014
Creekside Middle Sch 7:OOA to 6:OOP
3525 W. 126th Street M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317 8-7275
Cancel Reason: Ch�uq n plans
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 6.00
Processed on 06/09/14 @ 14:16:52 by BJJ FEES CHANGED ON CANCELLED ITEMS(+) 175.00-
SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 7.00-
NET AMOUNT FROM CANCELLEDEITEMS168.00
TOTAL_AMOUNT REFUNDED, -_• "'168.00:'
NEW NET CREDIT HOUSEHOLD BALANCE 6.00
Refund of=_> 168.00 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.
l
Aut rued S' ure Date Authorized Signature Date
Escape Day Passes are non-refundable.
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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.
Starace, Christina Terms
11554 Belmont Ct Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/9/14 1269751 Refund $ 168.00
Total $ 168.00
I hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with I C 5-11-10-1.6
, 20
Clerk-Treasurer
f
Voucher No. Warrant No.
I.
Starace, Christina Allowed 20
11554 Belmont Ct
Carmel, IN 46032
n Sum of$
I
i
$ 168.00 i.
1,
ON ACCOUNT OF APPROPRIATION FOR �.
108 -ESE
1
I
Po#or { Board Members
Dept# INVOICE NO. ACCT#/TITL AMOUNT
1082-11 1269751 4358400 $ 168.00 I hereby certify that the attached invoice(s), or
l bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
I received except
1
I
I
9-Jun 2014
(1 rn
Signature
$ 168.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund