189353 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 364636 Page 1 of 1
ONE CIVIC SQUARE SHIRLEY HALPERN
CHECK AMOUNT: $12.00
CARMEL, INDIANA 46032 417 MCLAREN LANE
CARMEL IN 46032 CHECK NUMBER: 189353
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 12.00 REFUND
ACTIVITY REFUND RECEIPT
Receipt 509567
Payment Date: 08/19/10
Household 36018
Monon Community Center Shirley Halpern Hm Ph: (317)844 -0544
Carmel IN 46032 417 McLaren Lane
Carmel IN 46032 Cell Ph:
jerrybond @juno.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 12.00
Enrollee Name: Shirley Halpern Fees +Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 107002 -03 Bridge Practice Play 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 07131/2010 (Cancelled)
Primary Instructor: CCPR Staff
Class Location: Program Room A Class Dates: 08/18/2010 to 08/18/2010
Monon Community Cntr 6:45P to 8:15P
W
Carmel IN 46032 Scheduled Sessions: 1
(317)848 -7275
Cancel Reason: staff cancellation
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08119/10 09.33:27 by MML FEES CHANGED ON CANCELLED ITEMS 12.00
NET AMOUNT FROM CANCELLED ITEMS 12.00
TOTAL AMOUNT REFUNDED 12.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 12.00 Made By REFUND FINAN With Reference staff cancellation
All refunds a subje to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. o a or it card refunds.
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AUG 1 9 2010
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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.
Halpern, Shirley Terms
417 McLaren Lane Date Due
Carmel, 1N 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8119110 509567 Refund 12.00
Total 12.00
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.
Halpern, Shirley Allowed 20
417 McLaren Lane
Carmel, IN 46032
In Sum of
12.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -50 509567 4358400 12.00 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
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Signature
12.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund