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Home My WebLink About198469 06/22/2011 CITY OF CARMEL, INDIANA VENDOR: 365425 Page 1 of 1 ONE CIVIC SQUARE JUSTIN CLEVENGER CHECK AMOUNT: $103.00 CARMEL, INDIANA 46032 423 STOCKBRIDGE DRIVE WESTFIELDIN 46074 CHECK NUMBER: 198469 CHECK DATE: 6/2212011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4358400 103.00 REFUND ACTIVITY REFUND RECEIPT Receipt 630934 Payment Date: 06/06/11 Household 18145 Monon Community Center Justin Clevenger Hm Ph: (317)569 -3954 Carmel IN 46032 423 Stockbridge Drive Wk Ph: (317)569 -4270 Westfield IN 46074 Cell Ph: (317)645 -5703 diverjenclevy @yahoo.com Phone: (317)848-7275 Fed Tax ID #35- 6000972 Enrollment Details CANCELLATION Refund Of 48.00 Enrollee Name: Owen Clevenger Fees Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 113006-12 Learn to Swim Lvl 1 0.00 0.00 0.00 0.00 0.00 Enrollment Date: 05/19/2011 (Cancelled) E: ;s tea. .p. Class Location: Indoor Lap Pool 1 Class Dates: 06/13/2011 to 06/16/2011 Monon Community Cntr 10:OOA to 10:55A UN l) 201 M,Tu,W,Th Carmel, IN 46032 Scheduled Sessions: 4 (317)848 -7275 Cancel Reason: Advanced Request CANCELLATION Refund Of 55.00 Enrollee Name: Ada Clevenger Fees Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 113006 -12 Learn to Swim Lvl 1 7.00 0.00 0.00 7.00 0.00 Enrollment Date: 05/19/2011 (Cancelled) Class Location: Indoor Lap Pool 1 Class Dates: 06/13/2011 to 06/16/2011 Monon Community Cntr 10:OOA to 10:55A M,Tu,W,Th Carmel IN 46032 Scheduled Sessions: 4 (317)848 -7275 Cancel Reason: Advanced Request PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 06/06/11 14:14:20 by ERM FEES CHANGED ON CANCELLED ITEMS 110.00 SURCHARGE APPLIED AGAINST CANCELLED FEES 7.00 dam^' INN ET�AMO.UNT FROMECANCELLEDtITEMSI=* „�103A0 LOSS JTiOTAL�AMOUN7d6EF,UNDEDUZ NEW NET HOUSEHOLD BALANCE 0.00 Refund of 103.00 Made By REFUND FINAN With Reference Check Refund 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. Authorized Signature Date Authorized Signature Date (C��<P.14. ''l3 SPA iC7U 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. Clevenger, Justin Terms 423 Stockbridge Drive Date Due Westfield, IN 46074 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 616111 630934 Refund 103.00 Total 103.00 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 1 20 Clerk- Treasurer Voucher No. Warrant No. Clevenger, Justin Allowed 20 423 Stockbridge Drive Westfield, IN 46074 In Sum of 103.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1096 -10 630934 4358400 103.00 1 hereby certify that the attached invoice(s), or bil'.(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 16 -Jun 2011 &h &MrW Signature 103.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund