HomeMy WebLinkAbout202759 10/11/2011 CITY OF CARMEL, INDIANA VENDOR: 365708 Page 1 of 1
ONE CIVIC SQUARE AMY SIEKMAN
(i CHECK AMOUNT: $46.00
CARMEL, INDIANA 46032 6539 W WINDING BEND
MCCORDSVILLE IN 46055 CHECK NUMBER: 202759
CHECK DATE: 10/11/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 46.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 731196
Payment Date: 09/15/11
Household 34830
lonon Community Center 0 �Q� kJ Amy Siekman Hm Ph: (608)780 -0631
armel IN 46032 6539 W Winding Bend
McCordsville IN 46055 Cell Ph:
acsiekman @yahoo.com
hone: (317)848 -7275
ed Tax ID #35- 6000972
nrollment Details
CANCELLATION
Enrollee Name: Tyler Siekman Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 218001 -01 Teen Night Out 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 09/15/2011 (Cancelled)
Class Location: Party Rooms A B Class Dates: 09/23/2011 to 09/23/2011
Monon Community Cntr 5:30P to 9:30P
F
Carmel, IN 46032 Scheduled Sessions: 1
(317)848 -7275
Cancel Reason: Staff error
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 46.00
Processed on 09/15/11 14:44:53 by BNT FEES CHANGED ON CANCELLED ITEMS 0.00
NETAMOUNT'FROM:CANCELLED:ITEMS -0:00
HH BALANCE APPLIED TO THIS RECEIPT 46.00
TOTAL ?AM0 UNT REFUNDED:':i:::::;:i:::; e::46.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 46.00 Made By REFUND FINAN With Reference staff error
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 Signat r Date Authorized Signature Date
Volunteer with Us!
Volunteers are the foundation of Carmel Clay Parks Recreation and we need your help! We are currently seeking volunteers
for: Tour de Carmel (September 10), Barktember (September 11), and our Adaptive Programs (ongoing throughout the year).
If interested, please call Dana at 317.843.3868 or register online at https:// 2011cprv. theregistrationsysteni .com /en /l033!
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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.
Siekman, Amy Terms
6539 W Winding Bend Date Due
McCordsville, IN 46055
Invoice Invoice Description
Date !Number (or note attached invoice(s) or bill(s)) Amount
9115111 731196 Refund 46.00
Total 46.00
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.
Siekman, Amy Allowed 20
6539 W Winding Bend
McCordsville, IN 46055
In Sum of
i
46.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or iNVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -70 731196 4358400 46.00 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
7 -Oct 2011
Signature
46.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund