241777 02/03/15 y uj.4A_gy
�>`! CITY OF CARMEL, INDIANA VENDOR: 369074
3'. ONE CIVIC SQUARE HONGYAN LU CHECK AMOUNT: $********60.00*
:4 CARMEL, INDIANA 46032 316 MEADOW LANE APT 3 CHECK NUMBER: 241777
'F9�`TON'�` CARMEL IN 46032 CHECK DATE: 02/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 60.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt# 1399084
ar ,•* 1? Payment Date: 01/27/15
rksA creat�ofl Household#: 48418
Monon Community Center Hongyan Lu Hm Ph: (319)541-5743
Carmel IN 46032 316 Meadow Lane Apt. 3
Carmel IN 46032 Cell Ph:
Iv_hongyan@hotmail.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Enrollment Details
Enrollee Name: Angelina Tan Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476012-06 School's Out Camp 45.00 0.00 0.00 45.00 0.00
Enrollment Date: 01/27/2015 (Enrolled)
Class Location: West Clay Elementary Class Dates: 12/23/2014 to 12/23/2014 _ -
- West Clay Elementary 7:OOA to 6:OOP
3495 W. 126th St. Tu
Carmel, IN 46032 Scheduled Sessions: 1
(317)844-9961
Enrollee Name: Angelina Tan Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476012-10 School's Out Camp 45.00 0.00 0.00 45.00 0.00
Enrollment Date: 01/27/2015 (Enrolled)
Class Location: West Clay Elementary Class Dates: 12/30/2014 to 12/30/2014
West Clay Elementary 7:OOA to 6:OOP
3495 W. 126th St. Tu
Carmel, IN 46032 Scheduled Sessions: 1
(317)844-9961
Enrollee Name: Stephanie Tan Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476012-06 School's Out Camp 45.00 0.00 0.00 45.00 0.00
Enrollment Date: 01/27/2015 (Enrolled)
Class Location: West Clay Elementary Class Dates: 12/23/2014 to 12/23/2014
West Clay Elementary 7:OOA to 6:OOP
3495 W. 126th St. Tu
Carmel, IN 46032 Scheduled Sessions: 1
(317)844-9961
Enrollee Name: Stephanie Tan Fees+Tax Discount Prev Paid Cur Paid Amount Due
-- -Activity Number: - 476012-10 Schools Out Camp- 45.00 - 0.00 - -- ___0.00_..._._ 45.00_-_V____0.00-____
Enrollment Date: 01/27/2015 (Enrolled)
Class Location: West Clay Elementary Class Dates: 12/30/2014 to 12/30/2014
West Clay Elementary 7:OOA to 6:OOP
3495 W. 126th St. Tu
Carmel, IN 46032 Scheduled Sessions: 1
(317)844-9961
Enrollee Name: Angelina Tan Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476012-05 School's Out Camp 45.00 0.00 0.00 45.00 0.00
Enrollment Date: 01/27/2015 (Enrolled -Transfer from 476012-04(School's Out Camp))
Page# 1 of 3
ACTIVITY REFUND RECEIPT
rnle� Receipt# 1399084
rks&Recreation Payment Date: 01/27/2015
Household M 48418
Class Location: West Clay Elementary Class Dates: 12/22/2014 to 12/22/2014
West Clay Elementary 7:OOA to 6:OOP
3495 W. 126th St. M
Carmel, IN 46032 Scheduled Sessions: 1
(317)844-9961
Enrollee Name: Angelina Tan Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476012-09 School's Out Camp 45.00 0.00 0.00 45.00 0.00
Enrollment Date: 01/27/2015 (Enrolled-Transfer from 476012-08(School's Out Camp))
Class Location: West Clay Elementary Class Dates: 12/29/2014 to 12/29/2014
West Clay Elementary 7:OOA to 6:OOP
3495 W. 126th St. M
Carmel, IN 46032 Scheduled Sessions: 1
---
Enrollee Name: Stephanie Tan Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476012-05 School's Out Camp 45.00 0.00 0.00 45.00 0.00
Enrollment Date: 01/27/2015 (Enrolled -Transfer from 476012-04(School's Out Camp))
Class Location: West Clay Elementary Class Dates: 12/22/2014 to 12/22/2014
West Clay Elementary 7:OOA to 6:OOP
3495 W. 126th St. M
Carmel, IN 46032 Scheduled Sessions: 1
(317)844-9961
Enrollee Name: Stephanie Tan Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476012-09 School's Out Camp 45.00 0.00 0.00 45.00 0.00
Enrollment Date: 01/27/2015 (Enrolled-Transfer from 476012-08(School's Out Camp))
Class Location: West Clay Elementary Class Dates: 12/29/2014 to 12/29/2014
West Clay Elementary 7:OOA to 6:OOP
3495 W. 126th St. M
Carmel, IN 46032 Scheduled Sessions: 1
(317)844-9961
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed-on 01/27/15-@ 1UB:50by JAB— FEES-ADJUSTED-ON-CLANGED-ITEMS(t, 60:00---
NET AMOUNT FROM CHANGED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 60.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 60.00 Made By=_>REFUN NAN With Reference==>parent requestT;81-99-4358400 refund
Paymen -- 360.00 Made B ctivity Registration Credit Balance
All refunds are su to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
is
thorized S' ature Date Authorized Signature Date
Page# 2 of 3
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.
Lu, Hongyan Terms
316 Meadow Lane Apt. 3 Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/27/15 1399084 Refund $ 60.00
Total $ 60.00
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
j
t _ J
Voucher No. Warrant No.
Lu, Hongyan Allowed 20
316 Meadow Lane Apt. 3
Carmel, IN 46032
In Sum of$
$ 60.00 ,
i
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITL AMOUNT
1081-99 1399084 4358400 $ 60.00 �l 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
i
January 29, 2015
f
Signature
$ 60.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund