246988 06/30/15 ' CAA .
`'' ';' CITY OF CARMEL, INDIANA VENDOR: 369526
® it ONE CIVIC SQUARE DON STAERKEL CHECK AMOUNT: $****"'346.00`
CARMEL, INDIANA 46032 14305 CARLOW RUN CHECK NUMBER: 246988
�,;,�'ON.�.r CARMEL IN 46074 CHECK DATE: 06/30/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 1453635 346.00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 1453635
Carmel o Clay Payment Date: 06/23/15
Household #: 61923
ion
Parks&Recrea
JUN 24 2015
Monon Community Center <, Don Staerkel Hm Ph: (952)820-5200
Carmel IN 46032 -- -- 14305 Carlow Run Wk Ph: (877)634-2545
Carmel IN 46074 Cell Ph:(952)820-5200
Phone: (317)848-7275 dstaerkel@yahoo.com
Fed Tax ID#35-6000972
Enrollment Details
CANCELLATION - Refund Of 166.00
Enrollee Name: Rylee Staerkel Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476001-17 Play On 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 03/03/2015 (Cancelled)
Class Location: Creekside Middle Sch Class Dates: 07/13/2015 to 07/17/2015
Creekside Middle Sch 7:OOA to 6:OOP
3525 W. 126th Street M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317 8
Cancel Reason: parent request
CANCELLATION - Refund Of 180.00
Enrollee Name: Rylee Staerkel Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number 476005-05 Stage-Stage Design 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 03/03/2015 (Cancelled)
Class Location: Multipurpose Room A Class Dates: 06/29/2015 to 07/03/2015
Monon Community Cntr 8:OOA to 5:30P
M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848-7275
Skip Days 07/04/2013, 07/05/2013
Cancel Reason: parent request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/23/15 @ 16:23:14 by BJJ FEES CHANGED ON CANCELLED ITEMS(+) 360.00-
SURCHARGE APPLIED AGAINST CANCELLED FEES(-) 14.00-
NET AMOUNT FROWCANCELLED ITEMS 346.00-
TOTAL AMOUNT REFUNDED 346.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 346.00 Made By==>REFUND FINAN 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.
1
Page# 1 of 2
Carmel * Clay ACTIVITY REFUND RECEIPT
Receipt# 1453635
Parks&Recreatidh Payment Date: 06/23/2015
Household #: 61923
Authori ignature Date Authorized Signature Date
Escape Day Passes are non-refundable.
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os) JUN 24 2015
Page# 2 of 2
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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.
Staerkei, Don Terms
14305 Carlow Run Date Due
Carmel, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/23/15 1453635 Refund $ 173.00
6/23/15 1453635 Refund $ 173.00
Total $ 346.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Allowed 20
Staerkel, Don
14305 Carlow Run
Carmel, IN 46074 In Sum of$
$ 346.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
Board Members
PO#or INVOICE NO. ACCT#/TITL AMOUNT
Dept#
1453635 4358400 $ 173.00 I hereby certify that the attached invoices , or
1082-6 173.00 bill(s)is(are)true and correct and that the
1082-11 1453635 4358400 $ materials or services itemized thereon for
which charge is made were ordered and
received except
June 25, 2015
Signature
$ 346.00 Accounts Payable Coordinator
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund