245733 06/03/15 CITY OF CARMEL, INDIANA VENDOR: 369105
} ONE CIVIC SQUARE JUSTINA ADAMS CHECK AMOUNT: $*******173.00*
s�. � CARMEL, INDIANA 46032 10375 ORCHARD PARK DR CHECK NUMBER: 245733
'+,,,._.,� INDIANAPOLIS IN 46280 CHECK DATE: 06/03/15
«ON�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 173.00 REFUNDS AWARDS & INDE
a ACTIVITY REFUND RECEIPT
ca � Receipt# 1448531
r Payment Date: 05/21/15 Cloy
Household#: 33874
N,r'kS&Re, creation
MAY 2 8 2015
Monon Community Center Justina Adams Hm Ph: (317)557-1062
Carmel IN 46032 � :_ I 10375 Orchard Park Dr.
Indianapolis IN 46280 Cell Ph:
Phone: (317)848-7275 justinanoel@comcast.net
Fed Tax ID#35-6000972
Enrollment Details
CANCELLATION -Refund Of 173.00
Enrollee Name: Victoria Adams Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476010-15 Boys Rock Girls Rule 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 02/10/2015 (Cancelled)
Class Location: Wilfong Pavilion A Class Dates: 06/29/2015 to 07/03/2015
Founders Park 8:OOA to 5:30P
11675 Hazel Dell Parkway M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
Skip Days 07/04/2013
Cancel Reason: parent request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 05/21/15 @ 18:00:10 by BJJ FEES CHANGED ON CANCELLED ITEMS(+) 180.00-
SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 7.00-
NET AMOUNT FROM.CANCELLED ITEMS, 173:00
TOTALAMOUNTAEFUNDED 173.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 173.00 Made By==>REFUND FINAN With Reference=_>
All refun are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issueedd.
J _K
A d Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
c
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.
Adams, Justina Terms
10375 Orchard Park Dr Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/21/15 1448531 Refund $ 173.00
Total $ 173.00
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.
Adams, Justina A lowed 20
10375 Orchard Park Dr
Indianapolis, IN 46280 I
IriSumof$
$ 173.00
I -
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITL AMOUNT
1082-14 1448531 4358400 $ 173.00 I'hereby certify that the attached invoice(s), or
bills)is(are)true and correct and that the
materials or services itemized thereon for
Which charge is made were ordered and
received except.
I
May 28,2015
Signature
$ 173.00 Accounts Payable Coordinator
Cost distribution ledger classification if J Title
claim paid motor vehicle highway fund