201008 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 365639 Page 1 of 1
ONE CIVIC SQUARE BRUCE SMITH
CARMEL, INDIANA 46032 3662 E CARMEL DR CHECK AMOUNT: $85.00
CARMEL IN 46033 CHECK NUMBER: 201008
CHECK DATE: 8/30/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 715983 85.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 715983
Payment Date: 08/17/11
Household 28680
Monon Community Center Bruce Smith Hm Ph: (317)910 -1884
Carmel IN 46032 3662 E Carmel Dr
Carmel IN 46033 Cell Ph: (616)403 -3730
ecsmith.smith@gmaii.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 85.00
Enrollee Name: Emily Smith Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 313020 -01 WSI Class 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 12/21/2010 (Cancelled)
Class Location: Indoor Lap Pool 6 Class Dates: 02/05/2011 to 02/13/2011
Monon Community Cntr 9:OOA to 6:OOP
Su,Sa
Carmel, IN 46032 Scheduled Sessions: 4
(317)848 -7275
Add'I Locations: Pool Observation Rm Class Dates: 02/05/2011 to 02/13/2011
Monon Community Cntr Meeting Times (Su) 9:OOA to 6:OOP, (Sa) 9:OOA to 6:OOP
Carmel, IN 46032
3178487275
Cancel Reason: Class Canceled Due to Low Enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/17/11 14:06:36 by ERM FEES CHANGED ON CANCELLED ITEMS 85.00
�INET4 "AMOUNTyFROM?CANCELLEDiI7EMS? 85[00=
G 1 ASS 4TOTAL§AMOUNTrIREFUNDED:
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 85.00 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.
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AUG 1 2011
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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.
Smith, Bruce Terms
3662 E. Carmel Dr. Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/17/11 715983 Refund 85.00
Total 85.00
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.
Smith, Bruce Allowed 20
3662 E. Carmel Dr.
Carmel, IN 46033
In Sum of
85.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -10 715983 4358400 85.00 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
26 -Aug 2011
A
Signature
85.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund