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CITY OF CARMEL, INDIANA VENDOR: 371300 CHECK AMOUNT: $********16.00* ONE CIVIC SQUARE JENNIFER GALDABINI-MCKEON CARMEL, INDIANA 46032 7352 B LIONS HEAD DRIVE CHECK NUMBER: 306283 INDIANAPOLIS IN 46260 CHECK DATE: 12/16/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4358400 2000456006 16.00 REFUNDS AWARDS & INDE « co 20 O k � - � f -5 U o z / CL � k q \ z =3 # K # e 2 m 2 \ k o p 0 / / g 0 co � ® J ƒ » E > - 2 17 E % CA § 0 -P. A $ $ a a o no Js 2 q q % 9C / § C) / / � � � e / ® f E © © > \ / Q R ] LT - D n m E e o m 0 f 2 $ k = � E 0 E E a q a ° Q o a R 0 O CD \ m - CD » \ C /\ _ ] CD 2 $ / \ / 2 / { / \ 0 2 CDC 0- / O CD oCL CD 9 0 ] o / k o ¢ 7 d CD | J o 12/14/2016 Receipt#2000456.006 Administrative Offices Voucher #2000456.006 1411 E. 116th Street Dec 14, 2016 7:04 PM Carmel, IN 46032 Phone: (317) 843-3875 FAX: -- • Email: info@carmelclayparks.com CaF e Clay Nrks&ReUeation JENNIFER GALDABINI-MCKEON NATIONAL GOLD MEDAL WINNER 7352 B LIONS HEAD DRIVE INDIANAPOLIS, IN 46260 AND ACCREDITED AGENCY Prepared By: michelley Customer ID: 43324 Primary phone: (317) 253-2353, Secondary phone: (317) 253-2353 Refund Summary Check: ($16.00) Check # Total Received: ($16.00) Total Refund: ($16.00) Transactions Customer Description Item Unit Qty Fee Charge 3ennifer GalldaWni- Adaptive Fantastic Friday#268040-04 Activity Each 1.00 $16.00 (;16.00) McKeon Action:Withdraw Fee 7352 B Lions Head Drive Withdrawal Date:Dec 14,2016 Indianapolis,IN 46260 Primary phone:(317)253- Meets:December 16,2016 2353 Friday from 5:30pm to 8:30pm Email: Location: mjgmckeon@gmal.com Party Room A at Monon Community Center West Building ID:43324 Party Room B at Monon Community Center West Building Total Charges ($16.00) Total Payments ($16.00) Balance $0 DEC 15 2016 BY: j2j [ u hdpsjiactvenet=.active.com/carmelclayparks/servletlprocessAdminLogin.sdl 111