187775 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 364416 Page 1 of 1
ONE CIVIC SQUARE ALLYSON DOMKE
CARMEL, INDIANA 46032 13475 CLIFTY FALLS DR CHECK AMOUNT: $240.00
`o CARMEL IN 46032 CHECK NUMBER: 187775
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 457071 240.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 457071
Payment Date: 06/29/10
Household 6186
Monon Community Center �u JUL 0 2 2010 DAllyson Domke Hm Ph: (317)706 -0348
Carmel IN 46032 13475 Clifty Falls Dr
Carmel IN 46032 Cell Ph:
dally176 @hotmail.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 120.00
Enrollee Name: Emma Domke Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476009 -17 Skyhawks Sports 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 06/03/2010 (Cancelled)
Class i Creekside Middle Sch Class Dates: 07!05/2010 to 07/09/2010
Creekside Middle Sch 1:OOP to 4 :OOP
3525 W. 126th Street M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions 5
(317)848 -7275
Cancel Reason: camp cancelled due to low enrollment
CANCELLATION Refund Of 120.00
Enrollee Name: Luke Domke Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476009 -17 Skyhawks Sports 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 06/03/2010 (Cancelled)
Class Location: Creekside Middle Sch Class Dates: 07/05/2010 to 07/09/2010
Creekside Middle Sch 1:OOP to 4:OOP
3525 W. 126th Street M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848 -7275
Cancel Reason: camp cancelled due to low enrollment
PREVIOUS NET HOUSEHOLD BALANCE 28.00
Processed on 06129/10 11:39:47 by LAA FEES CHANGED ON CANCELLED ITEMS 240.00
NET AMOUNT FROM CANCELLED ITEMS 240.00
TOTAL AMOUNT REFUNDED 240.00 t/
NEW NET HOUSEHOLD BALANCE 28.00
Refund of 240.00 Made By REFUND FINAN With Reference
All refunds are su`�t to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No cash credit card ref
/�l kOO
Authorized Sign to Date Authorized Signature Date
Page 1
f I
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.
Domke, Allyson Terms
13475 Clifty Falls Dr Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/29/10 457071 Refund 240.00
-Total 240.00
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.
Domke, Allyson Allowed 20
13475 Clifty Falls Dr
Carmel, IN 46032
In Sum of
240.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -98 457071 4358400 240.00 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
15 -Jul 2010
Signature
240.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund