190822 10/13/2010 CITY OF CARMEL, INDIANA VENDOR: 364789 Page 1 of 1
ONE CIVIC SQUARE SONATA JAKUCIONIENE
CARMEL, INDIANA 46032 203 E 106TH STREET CHECK AMOUNT: $55.00
s r' INDIANAPOLIS IN 46280
CHECK NUMBER: 190822
CHECK DATE: 10/1312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
1096 4358400 55.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 526467
Payment Date: 10/06/10
Household M. 36874
Monon Community Center Sonata Jakucioniene Hm Ph: (317)816 -0732
Carmel IN 46032 203 E 106th Street
Indianapolis IN 46280 Cell Ph: (317)919-0751
sigitas @gmail.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 55.00
Enrollee Name: Ugne Jakucioniene Fees Tax Discount Prev Paid Cur Paidl Amount Due
Activity Number: 203006 -05 Learn to Swim Lvl 1 0.00 0.00 0.00 0,00 0.00
Enrollment Date: 08/29/2010 (Cancelled)
Class Location: Indoor Lap Pool 1 Class Dates: 10/04/2010 to 10/25/2010
Monon Community Cntr 5:05P to &00P
M
Carmel, IN 46032 Scheduled Sessions: 4
(317)848 -7275
Cancel Reason: Class Canced Due to Low Enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10106(10 11:39:15 by ERM FEES CHANGED ON CANCELLED ITEMS 55.00
:'NEMAMOUNT FROM „CANCELLED ITEMS ;55
uTOTAL M0UNTAEFIJNDEWG6
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 55.00 Made By REFUND FINAN With Reference Low Enrollment
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.
10 G /V
Authorized Signature Date Authorized Signature Date
10(F6.
The Monon 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.
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.
Jakucioniene, Sonata Terms
203 E 106th Street Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10!6110 526467 Refund 55.00
Total 55.00
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.
Jakucioniene, Sonata Allowed 20
203 E 106th Street
Indianapolis, IN 46280
In Sum of
55.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -10 526467 4358400 55.00 i 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
7 -Oct 2010
LI /W o
Signature
55.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund