HomeMy WebLinkAbout187849 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 364423 Page 1 of 1
ONE CIVIC SQUARE BRIAN HARRIS
i, CARMEL, INDIANA 46032 750 BLISKSPORT LANE CHECK AMOUNT: $55.00
WESTFIELD IN 46074
CHECK NUMBER: 187849
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 456079 55.00 REFUNDS AWARDS INDE
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ACTIVITY REFUND RECEIPT
Receipt# 456079
Payment Date: 06/28/10
Household 34495
Monon Community Center brian harris Hm Ph: (317)590 -1731
Carmel IN 46032 J 0 750 bucksport lane
westfield in 46074 Cell Ph:
mharris2@clarian.org
PI gone: (317)848 -7275 Y
Fed Tax ID #35- 6000972
r
Enrollment Details
CANCELLATION Refund Of 55.00
Enrollee Name: jack harris Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476009 -05 Skyhawks Sports 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 04/20/2010 (Cancelled)
Class Location: Creekside Middle Sch Class Dates: 06/07/2010 to 06111/2010
Creekside Middle Sch 9:OOA to 10:OOA
3525 W. 126th Street M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848 -7275
Cancel Reason: not satisfied w/ skyhawks staffing lack of response /prep regarding injury
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/28/10 09:38:02 by BJJ FEES CHANGED ON CANCELLED ITEMS 55.00
NET AMOUNT :FROM CANCELLED ITEMS: 55 00 -1
TOTAL AMOLINT..REFUNDED
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 55.0 O�e By REFUND FINAN With Reference
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. N' cash or credit card refunds.
A ho ed Signature Date Authorized Signature Date
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Page 1
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.
Harris, Brian Terms
750 Bucksport Lane Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6128110 456079 Refund 55.00
Total 55.00
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
a
Voucher No. Warrant No.
Harris, Brian Allowed 20
750 Bucksport Lane
Westfield, IN 46074
In Sum of
55.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members
Dept ept
1082 -98 456079 4358400 55.00 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
fipjk)n�
Signature
55.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund