188258 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 364494 Page 1 of 1
ONE CIVIC SQUARE SUSAN BURSAW
CARMEL, INDIANA 46032 3254 SMOKEYRIDGE DRIVE CHECK AMOUNT: $78.00
CARMEL IN 46033
CHECK NUMBER: 188258
CHECK DATE: 8/312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 486553 78.00 REFUNDS AWARDS INDE
..t
ACTIVITY REFUND RECEIPT
Receipt 486553
Payment Date: 07/26110
Household 8666
Monon Community Center Susan Bursaw Hm Ph: (317)848 -1145
Carmel IN 46032 3254 Smokeyridge Dr
Carmel IN 46033 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 78.00
Enrollee Name: Susan Bursaw Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number. 107196 -01 Stretching Larger Tha 0.00 0 -00 0.00 0.00 0.00
Enrollment Date, 04/20/2010 (Cancelled)
Primary Instructor. CCPR Staff
Class Location: Art Studio Class Dates: 07/20/2010 to 08/24/2010
Monon Community Cntr 7:15P to 8 :15P
Tu
Carmel, IN 46032 Scheduled Sessions: 6
(317)848 -7275
Cancel Reason: low enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/26/10 15:05:49 by CNA FEES CHANGED ON CANCELLED ITEMS 78.00
NET. AMOUNT FROM CANCELLED ITEMS 78.00-
TOTAL AMOUNT` REFUNDED 78.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 78.00 Made By REFUND FINAN With Reference low enrollment
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.
7
Autiorized Signature Adwrized Signature D to
Enjoy your escape at the MCC.
JUL 2 7 2010
BY:
LA 00
low Lt `r W1r b 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.
Bursaw, Susan Terms
3254 Smokeyridge Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7126/10 486553 Refund 78.00
Total 78.00
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.
Bursaw, Susan Allowed 20
3254 Smokeyridge Dr
Carmel, IN 46033 Q
in Sum of
78.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT#MTLE AMOUNT Board Members
Dept
1096 -50 486553 4358400 78.00 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
29 -Jul 2010
Signature
78.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund