241486 1 /27/2015 (9,
CITY OF CARMEL, INDIANA VENDOR: 369063
ONE CIVIC SQUARE SHELIA CRAWFORD CHECKAMOUNT: $""""""*110.00*
CARMEL, INDIANA 46032 14150 BEN KINGSELY LANE CHECK NUMBER: 241486
CARMEL IN 46033 CHECK DATE: 01/27/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 1396161 110.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
ar�1 �e� p Receipt# 1Payment Date: 01/19/11/19/1
5
Household#: 57134
i rksAecreativr� S,
Monon Community Center Sheila Crawford Hm Ph: (773)315-5518
Carmel IN 46032 14150 Ben Kingsley Lane
`� f ,J� Carmel IN 46033 Cell Ph:
sheilacrawford22@gmail.com
Phone: (317)848-7275
Fed Tax ID#35-6000972 1 JAN 2 2 2015
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Enrollment Details
CANCELLATION -Refund Of 110.00
Enrollee Name: Claire Crawford Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 355102-01 Wee Move&Groove 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 01/08/2015 (Cancelled)
Class Location: Dance Studio B Class Dates: 01/20/2015 to 04/21/2015
Monon Community Cntr 10:30A to 11:OOA
Tu
Carmel, IN 46032 Scheduled Sessions: 13
(317)848-7275
Skip Days 04/07/2015
.Cancel Reason: Low Enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 01/19/15 @ 10:50:39 by AJACKSON FEES CHANGED ON CANCELLED ITEMS(+) 110.00-
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 110.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 110.00 Made By== REFUND FI AN 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.
Authorized 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.
Crawford, Sheila Terms
14150 Ben Kingsley Lane Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/19/15 1396161 Refund $ 110.00
II
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_ Total $ 110.00
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
20_
Clerk-Treasurer
Voucher No. Warrant No.
Crawford, Sheila Allowed 20
14150 Ben Kingsley Lane
Carmel, IN 46033
{In Sum of$
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$ 110.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-32 1396161 4358400 $ 110.00 I hereby certify that the attached invoice(s), or
fbill(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 22, 2015
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Signature
$ 110.00 j Accounts Payable Coordinator
Cost distribution ledger classification if ( Title
claim paid motor vehicle highway fund
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