192042 11/23/2010 CITY OF CARMEL, INDIANA VENDOR: 364875 Page 1 of 1
ONE CIVIC SQUARE SUSAN DESTRY
0 CHECK AMOUNT: $125.00
CARMEL, INDIANA 46032 15001 LITTLE EAGLE CREEK
oN _�o ZIONSVILLE IN 46077 CHECK NUMBER: 192042
CHECK DATE: 11/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 125.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 537109
Payment Date: 11/11/10
Household 31656
Monon Community Center Susan Destry Hm Ph: (317)431 -4677
Carmel IN 46032 15001 Little Eagle Creek
Zionsville IN 46077 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 125.00
Enrollee Name: Katie Destry Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 293019 02 Water Safety Instruc 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 11/09/2009 (Cancelled)
Class Location: Indoor Lap Pool Class Dates: 11/10/2009 to 12/08/2009
Monon Community Cntr 4:30P to 9:30P
Tu,Th
Carmel, IN 46032 Scheduled Sessions: 7
(317)848 -7275
Skip Days 11/24/2009, 11/26/2009
Cancel Reason: Reimbursement for WSI Class
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 11/11/10 13:01:32 by ERM FEES CHANGED ON CANCELLED ITEMS 125.00-
"NET AMOUNT, °FROM:'CANCELLED ,'ITEMS° x125 -00'
:TOTAL'"AMOUNT:REFUNDED A "�I. _`925.00R
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 125.00 Made By REFUND FINAN With Reference Reimbursement; Per Tess Pinter
r�-
All refunds are su 0 ect 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 Authorized Signature Date
is
NOV 1 5 X010
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.
Destry, Susan Terms
15001 Little Eagle Creek Date Due
Zionsville, IN 46077
Invoice Invoice Description
Date Number ERefund note attached invoices) or bills
Amount
D 125.00
11/11110 537109
Total 125.00
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.
Destry, Susan Allowed 20
15001 Little Eagle Creek
Zionsville, IN 46077
In Sum of
125.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -10 537109 4358400 125.00 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
18 -Nov 2010
Signature
125.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund