246595 06/17/15 (9 CITY OF CARMEL, INDIANA VENDOR: 369483
ONE CIVIC SQUARE YAN XU CHECK AMOUNT: $*******346.00*
CARMEL, INDIANA 46032 6549 IROQUOIS LANE CHECK NUMBER: 246595
CARMEL IN 46033 CHECK DATE: 06/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 346.00 REFUNDS AWARDS & INDE
' ACTIVITY REFUND RECEIPT
Receipt# 1449453
Payment Date: 05/27/15
Household#: 35218
Monon Community Center [� ;(�.,, y T- Yan Xu Hm Ph: (216)618-0367
Carmel IN 46032 6549 Iroquois Lane
JUN - 2 2015 Carmel IN 46033 Cell Ph:
xncg@hotmail.com
Phone: (317)848-7275
Fed Tax ID#35-6000972 qy '
Enrollment Details
CANCELLATION -Refund Of 166.00
Enrollee Name: Leo Shi Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476003-08 Outdoor Explorers 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 01/22/2015 (Cancelled)
Class Location: Multipurpose Room C Class Dates: 07/20/2015 to 07/24/2015
Monon Community Cntr 8:OOA to 5:30P
M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848-7275
Cancel Reason: parent request
CANCELLATION -Refund Of 180.00
Enrollee Name: Leo Shi Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476003-09 Outdoor Explorers 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 01/23/2015 (Cancelled)
Class Location: Multipurpose Room C Class Dates: 07/27/2015 to 07/31/2015
Monon Community Cntr 8:OOA to 5:30P
M,Tu,W,Th,F
Carmel, I Scheduled Sessions: 5
(31 -7275
Cancel Reason: Arent r que
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 05/27/15 @ 13:24:48 by BJJ FEES CHANGED ON CANCELLED ITEMS(+) 360.00-
SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 14.00-
<NET AMOUNT�FROM CANCELLED ITEMS, __346.00-1
l"JOTAL AMOUNT REFUNDED
,; 346 00-1
TOTALAMOUNTREFUNDED 346.00-
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 346.00 Made By=_>REFUND FINAN With Reference=_>
All ref,11xds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issue (�
J
A riled Signature Date Authorized Signature Date
Page# 1 of 2
` ACTIVITY REFUND RECEIPT
car'm e,I di Cla
Receipt# 1449463
Nrk s&Rjecreation Payment Date: 05/27/2015
Household M 35218
Escape Day Passes are non-refundable.
1�
Sv
l
Page# 2 of 2
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.
Xu, Yan Terms
6549 Iroquois Lane Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/27/15 1449453 Refund $ 346.00
Total $ 346.00
I hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with I C 5-11-10-1.6
20_
Clerk-Treasurer
Voucher No. Warrant No.
Xu,Yan Allowed 20
6549 Iroquois Lane
Carmel, IN 46033
In Sum of$
$ 346.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-3 1449453 4358400 $ 346.00 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
June 12, 2015
Signature
$ 346.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund