241586 01/27/15 CITY OF CARMEL, INDIANA VENDOR: 369064
4
.�; -1,• ONE CIVIC SQUARE TONY ROBERTSON CHECK AMOUNT: $*******1 10.00*
CARMEL, INDIANA 46032 10580 COPPERGATE CHECK NUMBER: 241586
9 �*ONCARMEL IN 46032 CHECK DATE: 01/27/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 110.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt# 1396163
Carmel * C1?y Payment Date: 01/19/15
Parks&Recreation Household M 38003
32_ . 1.!)58gC)0
Monon Community Center Tony Robertson Hm Ph: (317)797-8579
Carmel IN 46032 JAN 2.2 2015 Wk Ph: (317)428-4239
Carmel IN 493-3� 4on Cell Ph:(317)797-8579
#35-67275000972 BY_ kristenstrouse@indy.rr.com
Fed Tax ID#35-6
Phone: (31 105-BD C v PmR 6A-rF_
�
Enrollment Details
CANCELLATION -Refund Of 110.00
Enrollee Name: Victoria Robertson Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 355102-02 Wee Move&Groove 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 12/01/2014 (Cancelled) --
Class Location: Dance Studio B Class Dates: 01/21/2015 to 04/22/2015
Monon Community Cntr 11:OOA to 11:30A
W
Carmel, IN 46032 Scheduled Sessions: 13
(317)848-7275
Skip Days 04/08/2015
Cancel Reason: Low Enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 01/19/15 @ 10:52:46 by AJACKSON FEES CHANGED ON CANCELLED ITEMS(+) 110.00-
NET AMOUNT FROM CANCELLED ITEMS 110.00-
TOTAL AMOUNT REFUNDED 110.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_>_ _110.00 Made By=1>RE�FUNDFINAWith 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 Signat r Date Authorized Signature ate
Escape Day Passes are non-refundable. 1-1
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.
Robertson, Tony Terms
10580 Coppergate Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number - (or note attached invoice(s) or bill(s)) Amount
1/19/15 1396163 Refund $ 110.00
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.
I
Robertson, Tony Allowed 20
10580 Coppergate
Carmel, IN 46032 j
In Sum of$
I
$ 110.00
t
ON ACCOUNT OF APPROPRIATION FOR {
109 -MCC
PO#or INVOICE NO. ACCT#ITITLE AMOUNT Board Members
Dept#
1096-32 1396163 4358400 $ 110.00 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
I
January 22, 2015
Signature
Is 110.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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