241322 01/22/15 .`"'`-"*. CITY OF CARMEL, INDIANA VENDOR: 369035
�j *� ONE CIVIC SQUARE DORINDA LEWIS CHECK AMOUNT: S""****"112.00*
:9 ,Q CARMEL, INDIANA 46032 13466 ROCK CREEK DRIVE CHECK NUMBER: 241322
y,«oN��. CARMEL IN 46074 CHECK DATE: 01/22/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 1388320 112.00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
armel # Cl? Payment
# 1388320
Pa ment Date: 01/09/15
Household#: 16553
Nrks&Recreation =BY:
Monon Community CenterDorinda Lewis Hm Ph: (317)733-9448
Carmel IN 46032 13466 Rock Creek Drive Wk Ph: (317)269-4590
Carmel IN 46074 Cell Ph:(317)607-4116
Phone: (317)848-7275
Fed Tax ID#35-6000972
Enrollment Details
CANCELLATION -Refund Of 106.00
Enrollee Name: Dorinda Lewis Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 354205-03 Bellydance Workout 0.00 0.00 0.00 0.00 0.00
Enrollment Date: — 011013/2015-'- (Cancelled) -- — — -- —--
Class Location: Fitness Studio B Class Dates: 01/10/2015 to 02/28/2015
Monon Community Cntr 10:30A to 11:20A
Sa
Carmel, IN 46032 Scheduled Sessions: 8
(317)848-7275
Cancel Reason: low enrollment
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 6.00
Processed on 01/09/15 @ 15:15:21 by MEVANS FEES CHANGED ON CANCELLED ITEMS(+) 112.00-
NETAMOUNT.FROM CANCELLED ITEMS
TOTAL AMOUNT REFUNDED 112.00
NEW NET CREDIT HOUSEHOLD BALANCE 6.00
Refund of=_> 112.00 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.
vipa�D I dAll"
A&11#1
u ho i Signature Date Authorized Signature Date
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.
Lewis, Dorinda Terms
13466 Rock Creek Drive Date Due
Carmel, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
119115 1388320 Refund $ 112.00
Total $ 112.00
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with I C 5-11-10-1.6
, 20
Clerk-Treasurer
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Voucher No. Warrant No.
4
Lewis, Dorinda Allowed 20
13466 Rock Creek Drive 1
Carmel, IN 46074
In Sum of$
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$ 112.00
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ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
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PO#or ( Board Members
Dept# INVOICE NO. ACCT#/TlTLE AMOUNT
i
1096-22 1388320 4358400 $ 112.00 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
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January 15, 2015
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Signature
$ 112.00 I Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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