249288 09/09/1 5 CAA .
�'� ';� CITY OF CARMEL, INDIANA VENDOR: 368512
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d it ONE CIVIC SQUARE SHELLY HENLEY CHECK AMOUNT: $ ......20.00`
f. _ CARMEL, INDIANA 46032 13357 KICKAPOO TRAIL CHECK NUMBER: 249288
?y�_oN,�. CARMEL IN 46033 CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 20.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt# 1457480
Carni'e l * Clay Payment Date: 08/25/15
�� 7"f Household #: 14652
ParksAecreation --,
AUG 2 6 20115
Monon Community Center Shelly Henley Hm Ph: (317)810-9209
Carmel IN 46032 13357 Kickapoo Trail Wk Ph: (317) -
Carmel IN 46033 Cell Ph:(317)607-7599
jakensamsmom@yahoo.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Enrollment Details
CANCELLATION - Refund 01 8,00
Enrollee Name: Jacob Wittman Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 158080-25 Adaptive Flowrider 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 05/29/2015 (Cancelled)
Class Location: Flowrider Class Dates: 08/24/2015 to 08/24/2015
MC Outdoor Aquatics 5:30P to 7:OOP
M
Carmel, IN 46032 Scheduled Sessions: 1
Cancel Reason: Visit Refund
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 12.00
Processed on 08/25/15 @ 11:32:43 by MYADON FEES CHANGED ON CANCELLED ITEMS(+) 8.00-
NET AMOUNT FROM CANCELLED ITEMS 8.00-
HH BALANCE APPLIED TO THIS RECEIPT(+) 12.00-
TOTAL AMOUNT REFUNDED 20.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 20.00 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.
LX25// 2,L'tis 11
Authorized Signature Date Authorized Signature Date
Escape Day Passes are non-refundable.
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7
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.
Henley, Shelly Terms
13357 Kickapoo Trail Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/25/15 1457480 Refund $ 20.00
Total $ 20.00
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
Voucher No. Warrant No.
Henley, Shelly Allowed 20
13357 Kickapoo Trail
Carmel, IN 46033
In Sum of$
$ 20.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITL AMOUNT
1096-70 1457480 4358400 $ 20.00 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
September 4, 2015
Signature
$ 20.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund