188788 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 364531 Page 1 of 1
ONE CIVIC SQUARE LIZ ERICKSON
CARMEL, INDIANA 46032 14288 AUTUMN WOODS DRIVE CHECK AMOUNT: $38.00
WESTFIELD IN 46074 CHECK NUMBER: 188788
CHECK DATE: 8/18/2010
DEPARTMENT ACCOUNT PO N INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 492148 38.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 492148
Payment Date: 08/02/10
Household 15180
Monon Community Center Liz Erickson Hm Ph: (317)581 -1478
Carmel IN 46032 14288 Autumn Woods Drive
Westfield IN 46074 Cell Ph:
cndyliz@sbcglobal.net
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 38.00
Enrollee Name: Dylan Erickson Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 106319 02 Rock Solid Boot Camp 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 04/11/2010 (Cancelled)
Primary Instructor: Tumble Time
Class Location: Gymnasium B Class Dates: 07/24/2010 to 08/28/2010
Morton Community Cntr 12:15P to 1:00P
Sa
Carmel, IN 46032 Scheduled Sessions: 6
(317)848 -7275
Skip Days 07/03/2010
Cancel Reason: low enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/02110 10:48:12 by LVA FEES CHANGED ON CANCELLED ITEMS 38.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 38.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 38.00 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
issue No cash or credit card refunds.
Authorized Sign re r A� zed Signatur ate
Enjoy your escape at the MCC. l
AUU U 4 2010
0 q2
Lj
Page fi 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.
Erickson, Liz Terms
14288 Autumn Woods Drive Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
812110 492148 Refund 38.00
Total 38.00
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.
Erickson, Liz Allowed 20
14288 Autumn Woods Drive
Westfield, IN 46074
In Sum of
38.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -42 492148 4358400 38.00 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
12 -Aug 2010
Signature
38.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund