187865 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 364425 Page 1 of 1
ONE CIVIC SQUARE JENNIFER HOUSEHOLDER
CARMEL INDIANA 46032 3747 E CARMEL DR CHECK AMOUNT: $49.50
ter. CARMEL IN 46033
CHECK NUMBER: 187865
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 457929 42.50 REFUNDS AWARDS INDE
1082 4358400 464795 7.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 464795
Payment Date: 07/06/10
Household 27826
Monon Ccmmunity Center Jennifer Housholder Hm Ph: (317)663 -3314
Carmel IN 16032 3747 E. Carmel Dr
Carmel IN 46033 Cell Ph:
j.housholder @lilly.com
Pnone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 7.00
Enrollee Name: Zachary Housholder Fees Tax Discount Prev Paid Cur Paid Amount Due
Activilv Member- 476009 -27 Skyhawks Sports 49.50 0.00 49.50 0.00 0.00
E ,roll Wait late: 02/09/2010 (Cancelled)
Class Location: Creekside Middle Sch Cuss Dates: 07/19/2010 to 07/23/2010
Creekside Middle Sch 1:OOP to 3:OOP
3525 W. 126th Street M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848 -7275
PREVIOUS NET HOUSEHOLD BALANCE 28.00
Pror -d on 07/06/10 12:32:06 by BJJ FEES ADJUSTED ON CHANGED ITEMS 7.00
NET AMOUNT FROM CHANGED,ITEMS Zi00
TOTAL AMOUNT REFUNDED
NEW NET HOUSEHOLD BALANCE 28.00
7 .00 Made By REFUND FINAN With Reference
All refunds re subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. cash or credit card refunds.
n rued Signature Date Authorized Signature Date
JU
L
By.
Page 1
ACTIVITY REFUND RECEIPT
Receipt 457929
Payment Date: 06/30/10
Household 27826
Monon Community Center Jennifer Housholder Hm Ph: (317)663 -3314
Carmel IN 46032 3747 E. Carmel Dr
Carmel IN 46033 Cell Ph:
j.housholder @lilly.com
Phone: (317)848 -7275
_Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 42.50
Enrollee Name: Zachary Housholder Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476009 -27 Skyhawks Sports 56.50 0.00 49.50 7.00 0.00
Enrollment Date: 02/09/2010 (Cancelled)
Class Location: Creekside Middle Sch Class Dates: 07/1912010 to 07/23/2010
Creekside Middle Sch 1:OOP to 3:OOP
3525 W. 126th Street M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848 -7275
Cancel Reason: father called,something came up and needs to cancel
PREVIOUS NET HOUSEHOLD BALANCE 28.00
Processed on 06/30/10 11:07:00 by LAA FEES CHANGED ON CANCELLED ITEMS 49.50
SURCHARGE APPLIED AGAINST CANCELLED FEES 7.00
NET AMOUNT FROM CANCELLED ITEMS 42.5
TOTAL AMOUNT REFUNDED 42.50 V
NEW NET HOUSEHOLD BALANCE 28.00
Refund of 42.50 Made By REFUND FINAN With Reference
All refu ds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issue No cash or credit card refunds.
uthorized Signature Date Authorized Signature Date
JUL
By.
J 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.
Housholder, Jennifer Terms
3747 E Carmel Drive Date Due
Carmel, 1N 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
716110 464795 Refund 7.00
6130110 457929 Refund 42.50
Total 49.50
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Housholder, Jennifer Allowed 20
3747 E Carmel Drive
Carmel, IN 46033
In Sum of
49.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #ITITLE AMOUNT Board Members
Dept
1082 -98 464795 4358400 7.00 1 hereby certify that the attached invoice(s), or
1082 -98 457929 4358400 42.50 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
d
Signature
49.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund