238795 11/05/14 `��,..a4A,,. CITY OF CARMEL, INDIANA VENDOR: 368812
ONE CIVIC SQUARE GAIL DOLAN CHECK AMOUNT: $********69.00*
r ,+�
CARMEL, INDIANA 46032 11709 PRAIRIE PLACE CHECK NUMBER: 238795
kM,iYtie�'O. CARMEL IN 46033 CHECK DATE: 11/05/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 1360303 69.00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 1360303
Carmel oclAv, Payment Date: 10/28/14
j
Parks&Recreation Household#: 21729
Monon Community Center FBY:-
Enrollment
Gail Dolan Hm Ph: (317)844-0652
Carmel IN 46032ETD 11709 Prairie Place
9 2014 Carmel IN 46033 Cell Ph:
Phone: (317)848-7275
Fed Tax ID#35-6000972 Details
CANCELLATION -Refund Of 69.00
Enrollee Name: Gail Dolan Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 247012-02 Social Ballroom Danc 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 08/11/2014 (Cancelled)
Primary Instructor: Rob Jenkins
Class Location: Dance Studio Class Dates: 10/31/2014 to 12/12/2014
Monon Community Cntr 6:15P to 7:15P
F
Carmel, IN 46032 Scheduled Sessions: 6
(317)848-7275
Skip Days 11/28/2014
Cancel Reason: Advanced Request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10/28/14 @ 14:37:51 by JWH FEES CHANGED ON CANCELLED ITEMS(+) 76.00-
SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 7.00-
NET AMOUNT FROM CANCELLED ITEMS 69.00-
TOTAL AMOUNT REFUNDED 69.00.
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 69.00 Made By==>REFUND FINAN With Reference=_>Advanced Request
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
/0/4 g/��� ( � ll1U��1,�1/1 l n l4
Authorized Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
/0 0, y35 gC-1f0
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.
Dolan, Gail Terms
11709 Prairie Place Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/28/14 1360303 Refund $ 69.00
i
Total $ 69.00
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
, 20_
Clerk-Treasurer
i
Voucher No. Warrant No. l
Dolan, Gail Allowed 20
11709 Prairie Place
Carmel, IN 46033
In Sum of$
$ 69.00
I
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
I
PO#or INVOICE NO. ACCT#/T1TLE AMOUNT Board Members
Dept#
1096-50 1360303 4358400 $ 69.00 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
,I
31-Oct 2014
i 1
Signature
$ 69.00 j Accounts Payable Coordinator
Cost distribution ledger classification if Title
I
claim paid motor vehicle highway fund !
f
i
l