201197 09/13/2011 CITY OF CARMEL, INDIANA VENDOR: 365649 Page 1 of 1
ONE CIVIC SQUARE JOE EASTBURN CHECK AMOUNT: $8.00
CARMEL, INDIANA 46032 PO BOX 576
CARMEL IN 46082 CHECK NUMBER: 201197
CHECK DATE: 9/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 8.00 REFUND
ACTIVITY REFUND RECEIPT
Receipt 721604
Payment Date: 08/30/11
Household 3917
Monon Community Center Joe Eastburn Hm Ph: (317)846 -0135
Carmel IN 46032 P.O. Box 576 Wk Ph: (317)848 -0923
Carmel IN 46032 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 8.00
Enrollee Name: Kate Eastburn Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 119012 -02 20 mi -St. Vincent To 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 08/20/2011 (Cancelled)
Primary Instructor: CCPR Staff
Class Location: Parking Lot East Class Dates: 09/10/2011 to 09/10/2011
Monon Community Cntr 7:30A to 12:OOP
Sa
Carmel IN 46032 Scheduled Sessions: 1
(317)848 -7275
Cancel Reason: not going to be able to participate
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/30/11 20:04:55 by MJN FEES CHANGED ON CANCELLED ITEMS 8.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT REFUNDED 8.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 8.00 Made By REFUND FINAN With Reference
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 bate
I D q4 �S qo
/mac fdS +V"fa1S Mee'' hPS I C/o,- be (CA rm
Join us for St. Vincent Tour de Carmel, a bike ride along 10 -mile and 20 -mile r utes 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 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.
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.
Eastburn, Joe Terms
P.O. box 576 Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8130111 721604 Refund 8.00
>Total 8.00
I 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.
Eastburn, Joe Allowed 20
P.O. box 576
Carmel, IN 46032
In Sum of
8.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #(TITLE AMOUNT Board Members
Dept
1096 -60 721604 4358400 8.00 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 -Sep 2011
Signature
8.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund