189477 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 364645 Page 1 of 1
j ONE CIVIC SQUARE THOMAS PRIGMORE
CARMEL, INDIANA 46032 4681 BRIARWOOD TRACE CHECK AMOUNT: $7.00
CARMEL IN 46033
CHECK NUMBER: 189477
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 7.00 PARKS DEPARTMENT REFU
P•
ACTIVITY REFUND RECEIPT
Receipt 509805
Payment Date: 08/19/10
Household 17253
Monon Community Center Thomas Prigmore Hm Ph: (317)566 -9874
Carmel IN 46032 4681 Briarwood Trace
Carmel IN 46033 Cell Ph:
Phone: (317)848 -7275 prig6 @yahoo.com
Fed Tax ID #35- 6000972
Enrollment Details
ROSTER CHANGE Refund Of 7.00
Enrollee Name: Erika Prigmore Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 104201 -09 Zumba 28.00 0.00 28.00 0.00 0.00
Enrollment Date: 07/0112010 (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 13:33:55 by LWW FEES ADJUSTED ON CHANGED ITEMS 7.00
NET AMOUNT;FROM CHANGE01TEMS
.700
TOTAL4MOUNT 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.
Authorized Signature Date A thori d Signature Date
ENJOY YOUR ESCAPE!!!
0 (,,2 2.4 94 co
AUG 7 3 ?010
]BY:
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.
Prigmore, Thomas Terms
4681 Briarwood Trace Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/19110 509805 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.
Prigmore, Thomas Allowed 20
4681 Briarwood Trace
Carmel, IN 46033
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 509805 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
12
Signature
7.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund