189073 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: T359911 Page 1 of 1
ONE CIVIC SQUARE MICHAEL WILLIAMS
CARMEL, INDIANA 46032 619 BURR OAK DR CHECK AMOUNT: $38.00
CARMEL IN 46032
CHECK NUMBER: 189073
CHECK DATE: 8/18/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 492153 38.00 REFUNDS AWARDS INDE
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ACTIVITY REFUND RECEIPT
Receipt 492153
Payment Date: 08/02/10
Household 4053
Monon Community Center Michael Williams Hm Ph: (317)566-891 2
Carmel IN 46032 619 Burr Oak Drive Wk Ph: (317)237 -25b3
Carmel IN 46032 Cell Ph:
aewdad@hotmail.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 38.00
Enrollee Name: Lillian Williams Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 106329 -02 Rock Solid Boot Camp 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 05/13/2010 (Cancelled)
Primary Instructor: Tumble Time
Class Location: Gymnasium B Class Dates: 07/24/2010 to 08/28/2010
Morton Community Cntr 11:15A to 12:00P
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
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Processed on 08(02/10 10:50:12 by LVA FEES CHANGED ON CANCELLED ITEMS 3 8.00
NET AMOUNT FROM CANCELLED ITEMS 38.00
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TOTAL 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
iss No cash or credit card refunds.
81 21 1 0
Authorized 'g alure ate Authorj ed Signature Date
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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.
Williams, Michael Terms
619 Burr Oak Drive Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
812110 492153 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
20r I
Clerk- Treasurer
Voucher No. Warrant No.
Williams, Michael Allowed 20
619 Burr Oak Drive
Carmel, IN 46032
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 492153 4358400 38.00 l hereby certify that the attached invoice(s), or
biii(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
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Signature
38.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund