188084 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 364443 Page 1 of 1
ONE CIVIC SQUARE ROSEMARY TIPLICK
CARMEL, INDIANA 46032 14563 TWIN OAKS DR CHECK AMOUNT: $99.00
CARMEL IN 46032
CHECK NUMBER: 188084
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 457394 99.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt# 457394
Payment Date: 06/29/10
Household 21599
Morton Community enter
y JUL 0 2 2Q10 Rosemary Tiplick Hm Ph: (317)5$1 -1145
Carmel IN 46032 14563 Twin Oaks Dr. Wk Ph: (317)503 -9850
Carmel IN 46032 Cell Ph:
rtiplick @indy.rr.com
Phone: (317)848 -7275 Y
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 49.50
Enrollee Name: Kathryn Tiplick Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476009 -27 Skyhawks Sports 49.50 0.00 49.50 0.00 0.00
Enrollment Date: 0112312010 (Cancelled)
Class Location: Creekside Middle Sch Class 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
Cancel Reason: change In plans
CANCELLATION Refund Of 49.50
Enrollee Name: John Tiplick Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476009 -27 Skyhawks Sports 49.50 0.00 49.50 0.00 0.00
Enrollment Date: 01/23/2010 Cancelled)
Class Location: Creekside Middle Sch Class Dates: 07/19/2010 to 07/23/2010
Creekside Middle Sch 1:00P to 3:OOP
3525 W. 126th Street M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848 -7275
Cancel Reason: change in plans
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/29/10 14:12:43 by BJJ FEES CHANGED ON CANCELLED ITEMS 99.00-
NET 'AMOUNT FROM :CANCEL''LED ITEMS '9100
TOTAL 99:00.=
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 99.00 Made By REFUND FINAN With Reference
All refund.a subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No' sh or credit card re
Aut orize ignature Date Authorized Signature Date
13 j �.JJ aki f� 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.
Tiplick, Rosemary Terms
14563 Twin Oaks Dr Date Due
Carmel, IN 46032
Invoice I Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6129110 457394 Refund 99.00
Total 99.00
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.
Tiplick, Rosemary Allowed 20
14563 Twin Oaks Dr
Carmel, IN 46032
In Sum of
99.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE N0. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -98 457394 4358400 99.00 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
99.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund