205715 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 365649 Page 1 of 1
ONE CIVIC SQUARE JOE EASTBURN
CARMEL, INDIANA 46032 PO BOX 576 CHECK AMOUNT: $65.00
CARMEL IN 46082 CHECK NUMBER: 205715
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CHECK DATE: 1/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 65.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 773504
r I Clay Payment Date: 01/16/12
Pa rk s& Household 3917
Recreation
0 %(a
Monon Community Center J AN 1 g 2012 Joe Eastburn Hm Ph: (317)846 -0135
Carmel IN 46032 P.O. Box 576 Wk Ph: (317)848 -0923
Carmel IN 46032 Cell Ph:
PhSne: (317)848 -7275 BY^
Fcd Tax ID #35- 6000972
Enrollment Details
ROSTER CHANGE Refund Of 65.00
Enrollee Name: Gail Eastburn Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 324707 -01 MCC Weight Loss Chal 15.00 0.00 15.00 0.00 0.00
Enrollment Date: 01/05/2012 (Enrolled)
Class Location: Fitness Studio A Class Dates: 01/11/2012 to 03/14/2012
Monon Community Cntr 5:30P to 7:OOP
W
Carmel, IN 46032 Scheduled Sessions: 10
(317)848 7275
PREVIOUS NET HOUSEHOLD BALANCE 0.00
n P y rocessed on 01/116/12 08:45:42 by LWW (1 n FEES ADJUSTED ON CHANGED ITEMS 65.00-
W NET AMOUNT FROM CHANGED ITEMS 65.00-
LA)o �n�C�IJvL�V�c� U Cat I
t Q„ p TOTAL AMOUNT REFUNDED 65.00.
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 65.00 Made By REFUND FINAN With Reference Check refund
All refunds are subject to State Board of Accounts claim procedure and may take weeks to process. A check will be
issued. No cash or credit card refunds.
as2ol. i 5.20 2
1 /17/12-
Authorized Signature Date eAut4rld S re Date
Volunteer with Us!
Volunteers are the foundation of Carmel Clay Parks Recreation and we need your help! We are currently seeking volunteers
for special events, adaptive programs, parks and greenways, and Extended School Enrichment. If interested, please call Dana
at 317.843.3868 or register online at https:H2011cpry .theregistrationsystem.com /en /1033!
10 9 V 22. 'f35eL�00
Page 1 of 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.
Terms
Eastburn, Joe
Date Due
P.O. Box 576
Carmel, IN 46032
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
65.00
1116112 773504 Refund
Total 65.00
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.
Eastburn, Joe Allowed 20
P.O. Box 576
Carmel, IN 46032
In Sum of
65.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -22 773504 4358400 65.00 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 -Jan 2012
Signature
65.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund