HomeMy WebLinkAbout189549 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 364651 Page 1 of 1
ONE CIVIC SQUARE CHANDRELEKHA ULLATTIL 1
CARMEL, INDIANA 46032 3419 BURLINGAME BLVD CHECK AMOUNT: $7.00
WESTFIELDIN 46074
CHECK NUMBER: 189549
CHECK DATE: 8131/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 7.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 509818
Payment Date: 08/19/10
Household 19860
Monon Community Center Chandralekha Ullattil Hm Ph: (317)430
Carmel IN 46032 3419 Burlingame Blvd
westfield IN 46074 Cell Ph:
Phone: (317)848 -7275 c
Fed Tax ID #35- 6000972
Enrollment Details i
ROSTER CHANGE Refund Of 7.00
Enrollee Name: Chandralekha Ullattil Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 104201 -09 Zumba 28.00 0.00 28.00 0.00 I 0.00
Enrollment Date: 08/02/2010 (Enrolled)
Class Location: Dance Studio
Class Dates: 08/02/2010 to 08/23/2010
Monon Community Cntr 7:OOP to 7:50P
M
Carmel IN 46032 Scheduled Sessions: 4
(317)848 7275
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/19/10 13.51 :52 by LWW FEES ADJUSTED ON CHANGED ITEMS 7.00
NET- AMOUNT FROWC
I
TOTAL:AMOUNT.REFUNDED 1 7.0.0''
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NEW NET HOUSEHOLD BALANCE 0.00
Refund of 7.00 Made By REFUND FINAN With Reference Class cancelled 8130
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.
WOMcb 820-10
Authorized Signature Date A64orizeX Signature bate
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ENJOY YOUR ESCAPE!!! A 2 3 201
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BY:
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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.
I
Payee
Purchase Order No.
Ullattil, Chandralekha
3419 Burlingame Blvd Terms
Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s))
8/19/10 509818 Refund Amount
7.00
I
i
I
I
Total 7,80
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with 1C 5- 11- 10 -1.6
,20
Clerk-Treasurer
Voucher No, Warrant No.
Ullattil, Chandralekha Allowed 20
3419 Burlingame Blvd
Westfield, IN 46074
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 509818 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
kk-
Signature
7.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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