307972 02/13/17 CITY OF CARMEL, INDIANA VENDOR: 371480
GERRIT DEBOER CHECK AMOUNT: $""'"`""16.00'
ONE CIVIC SQUARE 1030 CHURCHILL COURT CHECK NUMBER: 307972
la CARMEL, INDIANA 46032 INDIANAPOLIS IN 46280 CHECK DATE: 02/13/17
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DEPARTMENTACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096
4358400 2001654003 16.00 REFUNDS AWARDS & INDE
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Z7/2017 Receipt#2001654.003
Monon Community Center East Building Voucher #2001654.003
1235 Central Park Dr. East Feb 7, 2017 12:37 PM
Carmel, IN 46032
FAX:Phone: (317) 848-7275 Car m el ! Clay
Email: info@carmelclayparks.com
Parks&Recreation
NATIONAL GOLD MEDAL WINNER
GERRIT DEBOER
1030 CHURCHILL COURT AND ACCREDITED AGENCY
INDIANAPOLIS, IN 46280
Prepared By: michelley
Customer ID: 56184
Primary phone: (317) 575-1993, Secondary phone: --
Refund Summar y
Check: ($16.00) Check #
Total Received: ($16.00) Total Refund: ($16.00)
_ l r ansactions
`.ustome: Descriptior, Itero Unit Qty Fee Charge
Caleb DeBoer Adaptive Fantastic Friday#378040-02 Activity Fee Each 1.00 $16.00 ($16.00)
1030 Churchill Court Action: Withdraw
Indianapolis,IN 46280 Withdrawal Date: Feb 7,2017
Primary phone: (317)575-
1993 Meets: February 17,2017
Email: gkdeboer@yahoo.com Friday from 5:30pm to 8:30pm
ID: 202 Location:
Party Room A at Monon Community Center West Building
Party Room B at Monon Community Center West Building
Total Charges ($16.00)
Total Payments ($16.00)
Balance $0
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