188321 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: T361071 Page 1 of 1
ONE CIVIC SQUARE JASON FLEMING
i CHECK AMOUNT: $32.50
,a CARMEL, INDIANA 46032 17474 EASTWICK CIRCLE
ory �o CARMEL IN 46033 CHECK NUMBER: 188321
CHECK DATE: 8/312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4355400 481309 32.50 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 481309
Payment Date: 07121/10
Household 10334
Monon Community Center Jason Fleming Hm Ph: (317)818 -8441
Carmel IN 46032 11974 Eastwick Circle
Carmel IN 46033 Cell Ph:
tchang @siumed.edu
-Phone: (317)848-7275
,Fed Tax ID #35- 6000972
ti
Enrollment Details
CANCELLATION
Enrollee Name: Mia Fleming Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number. 105241 -04 Beautiful Ballerina 32.50 0.00 0.00 32.50 0.00
Enrollment Date: 04/0112010 (Cancelled)
Class Location: Dance Studio B Cass Dates: 06/16/2010 to 08/04/2010
Monon Community Cntr 11:OOA to 11:30A
W
Carmel, IN 46032 scheduled sessions 8
(317)848 -7275
Cancel Reason: prorated refund
The following item reflects a payment towards a previous receipt
Enrollee Name: Tina Fleming Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 103007 -02 Learn to Swim Lvl 2 55.00 0.00 45.00 10.00 0.00
Enrollment Date, 04/01/2010 (Enrolled)
Primary Instructor. CCPR Staff
Class Location: Indoor Lap Pool 3 Class Dates: 05104/2010 to 05125/2010
Monon Community Cntr 5:05P to 6:00P
Tu
Carmel, IN 46032 Scheduled sessions: 4
(317)848 -7275
The following item reflects a payment towards a previous receipt
Enrollee Name: Tina Fleming Fees +Tax Discount Prey Paid Cur Paid Amount Due
Activity Number 103007 -12 Learn to Swim Lvl 2 55.00 0.00 0.00 22.50 32.50
Enrollment Date: 04/01/2010 (Enrolled)
Primary Instructor. CCPR Staff
Class Location: Indoor Lap Pool 3 Class Dates: 06/08/2010 to 06/17/2010
Monon Community Cntr 5:05P to 6:OOP
Tu,Th
Carmel, IN 46032 Scheduled Sessions: 4
(317)848 -7275
Page 1
ACTIVITY REFUND RECEIPT
Receipt 481309
Payment Date: 07/21/2010
Household 10334
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/21/10 13:11:33 by CNA FEES CHANGED ON CANCELLED ITEMS 65.00-
SURCHARGE APPLIED AGAINST CANCEi FEES 32.50
NET AMOUNT FROM CANCELLED ITEMS 32:50
FEES ADJUSTED ON CHANGED ITEMS 0.00
NET AMOUNT FROM CHANGED ITEMS D.OD
TOTAL AMOUNTREFUNDED 32.50,:
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 32.50 Made By REFUND FINAN with Reference prorated refund
Payment of 32.50 Made By Activity Registration Credit Balance
Rewards Points refunded on this receipt: 325
Household Reward Point Balance: 7.75
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.
6��AW 01 7L,2+1 7 7Z
Authorized Signature Date AUIWn2Q Signature Date
Enjoy your escape at the MCC.
JUL 2010
By:-
10 b. '39 .g358 00
-fro foAe& req u&E v P age 2
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.
Fleming, Jason Terms
11974 Eastwick Circle Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7121110 481309 Refund 32.50
Total 32.50
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
Fleming, Jason Allowed 20
11974 Eastwick Circle
Carmel, IN 46033
In Sum of
32.50
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -32 481309 4358400 32.50 l 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
32.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund