191675 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 364865 Page 1 of 1
0 ONE CIVIC SQUARE KATHY HELTON CHECK AMOUNT: $81.00
CARMEL, INDIANA 46032 6572 HUNTERS RIDGE SOUTH
ZIONSVILLE IN 46077 CHECK NUMBER: 191675
CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 81.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 533416
Payment Date: 10/27/10
Household 37094
Monon Community Center Kathy Helton Hm Ph: (317)344 -2604
Carmel IN 46032 Ion z 9 7010 6572 Hunters Ridge South
Zionsville IN 46077 Cell Ph:
kehelton @hotmail.com
Phone: (317)848 -7275 By
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 41.00
Enrollee Name: Leah Helton Fees +Tax Discount Prev Paid Cur Paid Amount Due
Activity Number. 205121 -06 Mom -N -Me Gymnastics 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 10/2612010 (Cancelled)
Class Location: Dance Studio B Class Dates: 11 /02/2010 to 11123/2010
Monon Community Cntr 5:15P to 5:45P
Tu
Carmel, IN 46032 Scheduled Sessions: 4
(317)848 -7275
Cancel Reason: advanced request
CANCELLATION Refund Of 40.00
Enrollee Name: Matthew Helton Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number. 205001 -04 Lil' Dragon Taekwond 7.00 0.00 0.00 7.00 0,00
Enrollment Date: 1012612010 (Cancelled)
Primary Instructor. Indy Taekwondo
Class Location: Gymnasium C Class Dates: 11102/2010 to 12/14/2010
Monon Community Cntr 4 :30P to 5:00P
Tu
Carmel, IN 46032 Scheduled Sessions: 7
(317)848 -7275
Cancel Reason: advanced request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10127110 11 :20:08 by CNA FEES CHANGED ON CANCELLED ITEMS 95.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 14.00
NET AMOUNT-FROM CANCELLED ITEMS 81.00-
TOTAL AMOUNT REFUNDED 81 00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 81.00 Made By REFUND FINAN With Reference advanced request
All refunds are subject to State Board of Accounts claim procedure and may to 4 -6 weeks to process. A check will be
issued. No cash or credit card refunds.
VUA,i V 1t1 a7 1U
Oq W. i 55U 1C CC Page #1
aolvmced regcte
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.
Helton, Kathy Terms
6572 Hunters Ridge South Date Due
Zionsville, IN 46077
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/27/10 533416 Refund 81.00
Total 81.00
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.
Helton, Kathy Allowed 20
6572 Hunters Ridge South
Zionsville, IN 46077
In Sum of
81.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO #or INVOICENO. ACCT# /TITLE AMOUNT Board Members
Dept
1096 -32 533416 4358400 81.00 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
4 -Nov 2010
Signature
81.00 Accounts Payable Coordinator
Cost distribution ledger classification if R Title
claim paid motor vehicle highway fund