312074 06/05/17 ,+u•t�q�f
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ONE CIVIC SQUARE RACHEL AKERS CHECK AMOUNT: $*******125.00*
a CARMEL, INDIANA 46032 6350 W BRIGHTON ROAD CHECK NUMBER: 312074
+,y GOSPORT IN 47433 CHECK DATE: 06/05/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 2000625006 125.00 REFUNDS AWARDS & INDE
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Receipt#2000625.006 Page 1 of 1
Administrative Offices Vbucher #2000625.006
1411 E. 116th Street pp`
Carmel, IN 46032 May 29, 2017 1:12 PM
Phone: (317) 848-7275
FAX: -- mEmail: info@carmelclayparks.com Car el
Clay
Parks&Recreation
RACHEL AKERS NATIONAL GOLD MEDAL WINNER
6350 W BRIGHTON RD
GOSPORT, IN 47433 AND ACCREDITED AGENCY
Prepared By: jordanh
Customer ID: 58885
Primary phone: (812) 876-3521, Secondary phone: --
Refund Summary
Check: ($125.00) Check #
Total Received: ($125.00) Total Refund: ($125.00)
Transactions
Customer Description Item Unit Qty Fee Charge
Madalyn Witt Lil' Kickers: Micro 4/5#175014-02 Activity Fee Each 1.00 $125.00 ($125.00)
15004 Riverdale Dr E Apt 2 Action:Withdraw
Carmel,IN 46033 Withdrawal Date: May 29, 2017
Primary phone:(812)821-
6799 Meets: From May 30, 2017 to August 1, 2017
Email:-- Each Tuesday from 11:30am to 12:20pm
ID:22654 Location: Carey Grove Park
Total Charges ($125.00)
Total Payments ($125.00)
Balance $0
�D�16-35- (4357-/00
https://anprod.active.com/carmelclayparks/servlet/processReceiptPayment.sdi 5/29/2017