190226 09/29/2010 CITY OF CARMEL, INDIANA VENDOR: 364731 Page 1 of 1
0 ONE CIVIC SQUARE JUDE CIESIELSKI CHECK AMOUNT: $64.00
CARMEL, INDIANA 46032 134 PEARL STREET
CARMEL IN 46032 CHECK NUMBER: 190226
CHECK DATE: 9/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 64.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 523517
Payment Date: 09/22/10
Household 30871
Morton Community Center Jude Ciesielski Hm Ph: (317)844 -4618
Carmel IN 46032 134 Pearl Street Wk Ph: (317)714 -6171
Carmel IN 46032 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 64.00
Enrollee Name: Paul Ciesielski Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 206410 -01 Hip Hop 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 09/15/2010 (Cancelled)
Primary Instructor: Dance Class Studio
Class Location: Dance Studio B Class Dates: 09/25/2010 to 11/13/2010
Morton Community Cntr 1:45P to 2:30P
Sa
Carmel, IN 46032 Scheduled Sessions: 8
(317)848 -7275
Cancel Reason: low enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 09/22/10 13:07:10 by LVA FEES CHANGED ON CANCELLED ITEMS 64.00
NET. AMOUNT -FROM CANCELLED ITEMS.: 64.00
TOTAL AMOUNT REFUNDED 64.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 64.00 Made By REFUND FINAN With Reference low enrollment
All refunds are subject to State Board of Accounts claim procedure and may take weeks to process. A check will be
issued. No cash or credit card refunds.
as .23.1i
Authorized Signature Date Aut ed Si ature Date
The Morton Community Center is a one -stop shop! Why drive all day searching for your local garage sale? Come to our
Community Garage Sale and leisurely browse through all sorts of items. The Community Garage Sale will take place Saturday,
October 9 from 10am -4pm at the MCC East Parking Lot. The event is free to the public.
Vendors: The fee for vendors is $5 /parking space. You must bring a table /chair. A limited number of tables and chairs will be
available at an additional cost of $5 each. In case of inclement weather, this event will be cancelled. To register, please
contact Sarah or fax your form to 317.573.5243.
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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.
Ciesielski, Jude Terms
134 Pearl Street Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9123110 523517 Refund 64.00
i
Total 64.00
1 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,
Ciesielski, Jude Allowed 20
134 Pearl Street
Carmel, IN 46032
In Sum of
64.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -42 523517 4358400 64.00 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
27 -Sep 2010
Signature
64.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund