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Home My WebLink About200645 08/17/2011 CITY OF CARMEL, INDIANA VENDOR: 365617 Page 1 of 1 ONE CIVIC SQUARE COURTNEY SYBOUTS CARMEL, INDIANA 46032 2030 EMERALD PINES LANE CHECK AMOUNT: $84.00 WESTFIELD IN 46074 CHECK NUMBER: 200645 CHECK DATE: 8/1712011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4358400 84.00 REFUNDS AWARDS INDE ACTIVITY REFUND RECEIPT Receipt 699871 Payment Date: 08/02/11 Household 42691 Monon Community Center Courtney Sybouts Hm Ph: (317)694 -0668 Carmel IN 46032 2030 Emerald Pines Lane Westfield IN 46074 Cell Ph: Phone: (317)848 -7275 crosybouts @gmail.com Fed Tax ID #35- 6000972 Enrollment Details CANCELLATION Refund Of 28.00 Enrollee Name: Courtney Sybouts Fees Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 114007 -06 Masala Bhangra 0.00 0.00 0.00 0.00 0.00 Enrollment Date: 07/05/2011 (Cancelled) Class Location: Fitness Studio B Class Dates: 08/05/2011 to 08/26/2011 Monon Community Cntr 6:OOP to 6:50P F Carmel, IN 46032 Scheduled Sessions: 4 (317)848 -7275 Cancel Reason: Instructor injury CANCELLATION Refund Of 28.00 Enrollee Name. Karen Sybouts _Fees Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 114007 -06 Masala Bhangra 0.00 0.00 0.00 0.00 0.00 Enrollment Date: 07/05/2011 (Cancelled) Class Location: Fitness Studio B Class Dates: 08/05/2011 to 08/26/2011 Monon Community Cntr 6:OOP to 6:50P F Carmel, IN 46032 Scheduled Sessions: 4 (317)848 -7275 Cancel Reason: Instructor Injury CANCELLATION Refund Of 28.00 Enrollee Name: Nicole Sybouts Fees Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 114007 -06 Masala Bhangra 0.00 0.00 0.00 0.00 0.00 Enrollment Date: 07/05/2011 (Cancelled) Class Location: Fitness Studio B Class Dates: 08/05/2011 to 08/26/2011 Monon Community Cntr 6:OOP to 6:50P F Carmel, IN 46032 Scheduled Sessions: 4 (317)848 -7275 Cancel Reason: Instructor injury Page 1 ACTIVITY REFUND RECEIPT Receipt# 699871 Payment Date: 08/02/2011 Household 42691 PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 08/02/11 12:16:21 by LWW FEES CHANGED ON CANCELLED ITEMS 84.00 NET AMOUNT"F,ROM'.CANCELLED ITEMS '84' °00- TOTAL�AMOONT, REFUNDED'" NEW NET HOUSEHOLD BALANCE 0.00 Refund of 84.00 Made By REFUND FINAN With Reference Instructor injury 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. �.5 I Authorized Signature Date O r4jthorize qt a Date Join us for St. Vincent Tour de Carmel, a bike ride along 10 -mile and 20 -mile routes through the city of Carmel. Rest stops will have a variety of healthy snacks, drinks and entertainment. After the ride, the finish line will offer more entertainment and refreshments. The cost is $8 per rider ($10 for same- dayday -of registration). Pre register online at www.carmelclayparks.com or pick up a form at the Monon Community Center. All participants will receive a goodie bag and a T -shirt if registered on or before August 26. The Adaptive 10 -mile Ride is for individuals with special needs only. Individuals will ride as a group on the 10 -mile route. Staff will be staggered within the group throughout the ride. Group will meet at the Monon Community Center in the designated tent at the start line for check -in at 8:00 a.m. Group will begin the ride at 8:30 a.m. sharp. UV�A#WCfD srkd_ 40 y A ov e 0 rvk lv�A4Y"ac+wu +D AtIaA�_ iku' lk"+ 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. Sybouts, Courtney Terms 2030 Emerald Pines Lane Date Due Westfield, IN 46074 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 812111 699871 Refund 84.00 Tota17 84.00 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. Sybouts, Courtney Allowed 20 2030 Emerald Pines Lane Westfield, IN 46074 In Sum of 84.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1096 -22 699871 4358400 84.00 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 9 -Aug 2011 Signature 84.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund