191284 10/27/2010 CITY OF CARMEL, INDIANA VENDOR: 364831 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA MARTIN
s. CARMEL, INDIANA 46032 11553 BELMONT COURT CHECK AMOUNT: $172.00
CARMEL IN 46032
CHECK NUMBER: 191284
CHECK DATE: 10/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 172.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 532263
Payment Date: 10/21/10
Household 37030
Monon Community Center i Cynthia Martin Hm Ph: (317)815 -0850
Carmel IN 46032 11553 Belmont Court
Carmel IN 46032 Cell Ph:
BY: cynthial1553 @aol.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 86.00
Enrollee Name: Cynthia Martin Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 207381 -02 Social Ballroom Danc 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 08/19/2010 (Cancelled)
Primary Instructor: Rob Jenkins
Class Location: Dance Studio Class Dates: 10/29/2010 to 12/17/2010
Monon Community Cntr 6:30P to 7:30P
F
Carmel IN 46032 Scheduled Sessions: 7
(317)848 -7275
Skip Days 11/26/2010
CANCELLATION Refund Of 86.00
Enrollee Name: Steve York Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number 207381 -02 Social Ballroom Danc 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 08/19/2010 (Cancelled)
Primary Instructor: Rob Jenkins
Class Location: Dance Studio Class Dates: 10/29/2010 to 12/17/2010
Monon Community Cntr 6:30P to 7:30P
F
Carmel IN 46032 Scheduled Sessions: 7
(317)848 -7275
Skip Days 11/26/2010
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10/21/10 10:10:10 by MML FEES CHANGED ON CANCELLED ITEMS 172.00
NET AMOUNT FROM CANCELLED ITEMS 172.00
TOTAL AMOUNT REFUNDED 172.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 172.00 Made By REFUND FINAN With Reference Illness
This refund will be mailed to
Page 1
ACTIVITY REFUND RECEIPT
Receipt 532263
Payment Date: 10/21/2010
Household 37030
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
Issued. N s or redi and refunds.
Authori d Si re Date Aut o e ignat a Date
s
Page 2
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.
Martin, Cynthia Terms
11553 Belmont Court Date Due
Carmel, I N 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/21/10 532263 Refund 172.00
Total 172.00
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,
Martin, Cynthia Allowed 20
11553 Belmont Court
Carmel, IN 46032
In Sum of
172.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -50 532263 4358400 172.00 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
21 -Oct 2010
Signature
172.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund