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307541 01/25/17
CITY OF CARMEL, INDIANA VENDOR: 371481 CHECK AMOUNT: $"«""««"«65.00" g ONE CIVIC SQUARE BRIAN ROGERS ?� CARMEL, INDIANA 46032 2 WILSON DRIVE CHECK NUMBER: 307541 MIiON. CARMEL IN 46032 CHECK DATE: 01125117 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4358400 2000492006 65.00 REFUNDS AWARDS & INDE < % % ] O \ C) © a f / E 2 0 40 0 K) X f ■ o z 0 ■ o j ( S \ ] \ # 2 £ 0 K ® o a ■ / N m / k 0 to -n 0 7 CD CL & % � } cc w \ 0 ; k 0 ƒ / 00 C)o ® \ % \ % 2 CL _ w > 0 P 2 $ \ ¥ � k k G f ] E - D \ / � !� e e ` ::rCD § $ & \ MCL CD ° \ Q 0 0 f ( k 3 f m \ _& @ % « CD - / ) ƒ E I / § k 2 0 \ ° M i - 0 / a 0 w ) / k \ K R § 7 A j k CL / / � or CD CD f | / a V,QR017 RPt Administrative offices Voucher #2000492.006 1411 E. 116th Street )an 10, 2017 3:36 PM Carmel, IN 46032 Phone: (317) 843-3875 FAX: -- SClay Email: info@carmelclayparks.com arme Rarks&Recreation BRIAN ROGERS NATIONAL GOLD MEDAL WINNER 2 WILSON DRIVE CARMEL, IN 46032 AND ACCREDITED AGENCY Prepared By: michelley Customer ID: 816 Primary phone: (317) 569-7178, Secondary phone: -- Refund Summary Check: ($65.00) Check # Total Received: ($65.00) Total Refund: ($65.00) Transactions Customer Description Item Unit Qty Fee Charge Deewy Reg— Adaptive Biking Basics*378011-01 Activity Each 1.00 ;65.00 (#65.00) 2 Wilson Drive Arbon:Wthdraw Fee carmei,IN 46032 Withdrawal Date:Jan 10,2017 Primary phone:(317)569- 7178 Meets:From January 12,2017 t0 Mame 2,2017 may: Each Thursday from 6:30pm to 7:15pm brien.rogers@aan.org Location: ID: 19505 Total Charges ($65.00) Total Payments ($65.00) Balance $0 RECEIVED JAN 1 3 2017 IC/ Yvl BY: ..............................j � Cl topsJMctivene1Q23 acYve �sessi0rid=4p�c7gBBsrgw,u9lyfwdBOrp Vt