189418 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 364641 Page 1 of 1
ONE CIVIC SQUARE TINA LAZAR CHECK AMOUNT: $7.00
CARMEL, INDIANA 46032 9933 HAMBLIN COURT
INDIANAPOLIS IN 46280 CHECK NUMBER: 189418
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 7.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 509789
Payment Date: 08/19/10
Household 25721
Monon Community Center Tina Lazar Hm Ph: (317)755 -6711
Carmel IN 46032 9933 Hamblin Ct.
Indianapolis IN 46280 Cell Ph: (317)755-6711
Phone: (317)848 -7275
Fed Tax 10 #35- 6000972
Enrollment Details
ROSTER CHANGE Refund Of 7.00
Enrollee Name: Tina Lazar Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number 104201 -09 Zurnba 28.00 0.00 28.00 0.00 0.00
Enrollment Date: 07/1912010 (Enrolled)
Class Location: Dance Studio Class Dates: 08/02/2010 to 08/30/2010
Monon Community Cntr 7:OOP to 7:50P
M
Carmel IN 46032 Scheduled Sessions: 5
(317)848 7275
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/19/10 1323:29 by LWW FEES ADJUSTED ON CHANGED ITEMS 7
NET;AMOUNTFROKCHANGED ITEMS:: 7:00
TOTAL AMOUNT�REFUNDED"
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 7.00 Made By REFUND FiNAN With Reference Class cancelled 8/30
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.
&oOL 3.19.10 8.20.1
Authorized Signature Date Authorize Signature Date
ENJOY YOUR ESCAPE!!! �U Z 2 I 3 `7"
AIJG 2010
B 'T o ....................o.o
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.
Lazar, Tina Terms
9933 Hamblin Ct. Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/19/10 509789 Refund 7.00
Total 7.00
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
Lazar, Tina Allowed 20
9933 Hamblin Ct.
Indianapolis, IN 46280
In Sum of
7.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1096 -22 509789 4358400 7.00 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
26 -Aug 2010
L A&Af�
Signature
7.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund