188100 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 364445 Page 1 of 1
0 ONE CIVIC SQUARE DAVID VANBIBBER
.y� CARMEL, INDIANA 46032 13219 HASKELL PL CHECK AMOUNT: $35.00
WESTFIELD IN 46074 CHECK NUMBER: 188100
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 475135 35.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 475135
Payment Date: 07/15/10
Household 29887
"':r 7, 7 "r
I
Monon Community Center JU� 1 5 David Vanbibber Hm Ph: (317)873 -2849
Carmel IN 46032 13219 Haskell PI.
Westfield IN 46074 Cell Ph:
Phone: (317)848 -7275 BY:
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 35.00
Enrollee Name: Drew Vanbibber Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 103004 -47 Preschool Level 2 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 06/0312010 (Cancelled)
Primary Instructor CCPR Staff
Class Location: Outdr Leisure Pool 3 Class Dates: 07/19/2010 to 07/22/2010
Monon Community Cntr 10:15A to 11:ODA
M,Tu,W,Th
Carmel IN 46032 Scheduled Sessions: 4
(317)848 -7275
Cancel Reason: Advanced Request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/15/10 10:33:03 by ERM FEES CHANGED ON CANCELLED ITEMS 42.00
t rpl� 1' 1 a ,7, I SURCHARGE APPLIED AGAINST CANCELLED FEES O 7.00
JUL 52010 kNETei 4MOUNTiFROMICANCELLEUiilTEMSP' 35f00
1 u'
u.TiOTALreAMOUNT�REFUNDEDZ. f!,II s'i x2t A t' a. '�,i 35t00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 35.00 Made By REFUND FINAN With Reference Advanced Request
Rewards Points refunded on this receipt: 0.70
Household Reward Point Balance: 0.70
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No cash or credit card refunds.
Authorized Signature D6te Authorized Signature Date
1 d y( /0 q3(� 400
Enjoy your escape at the MCC.
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.
Vanbibber, David Terms
13219 Haskell PI Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7115110 475135 Refund 35.00
Total 35.00
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.
Vanbibber, David Allowed 20
13219 Haskell PI
Westfield, IN 46074
In Sum of
35.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -10 475135 4358400 35.00 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
35.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund