187975 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 364431 Page 1 of 1
ONE CIVIC SQUARE KINGDON OFFENBACKER CHECK AMOUNT: $80.00
CARMEL, INDIANA 46032 4000 OAKLEAF OR
a o ZIONSVILLE IN 46077 CHECK NUMBER: 187975
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 465761 80.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 465761
Payment Date: 07/07/10
Household 33075
Monon Community Center Kingdon Offenbacker Hm Ph: (317)704 -3279
Carmel IN 46032
^n �arrxiel -IPd Cell Ph:
koffenbacker @echosupply.com
Phone: (317)848 -7275 �ILLGr
Fed Tax ID #35- 60009725
Enrollment Details
CANCELLATION Refund Of 80.00
Enrollee Name: Soren Offenbacker Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476002 -06 Preschool Palace 80.00 0.00 80.00 0.00 0.00
Enrollment Date: 04/28/2010 (Cancelled)
Class Location: Orchard Park Elem Class Dates: 07/05/2010 to 07/09/2010
Orchard Park Element 8:30A to 5:30P
10404 Orchard Park Drive South M,Tu,W,Th,F
Indianapolis, IN 46280 Scheduled Sessions: 5
(317)848 7275
Cancel Reason: change in plans
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/07/10 11:12:28 by BJJ FEES CHANGED ON CANCELLED ITEMS 80.00
NET AMOUNT FROM CANCELLED ITEMS 80.00
TOTAL AMOUNT REFUNDED 80.00 f
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 80.00 Made 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 thgri ignature Date Authorized Signature Date
a TT17 W ITO is
JUL '-1 2 2010 Y
BY:
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.
Offenbacker, Kingdon Terms
4000 Oakleaf Dr Date Due
Zionsville, IN 46077
Invoice Invoice Description
Date Number
or note attached invoice(s) or bill(s)) Amount
80.00
7!7110 465761 Refund
Total 80.00
I 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.
Offenbacker, Kingdon Allowed 20
4000 Oakleaf Dr
Zionsville, IN 46077
In Sum of
80.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -2 465761 4358400 80.00 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
80.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund