207276 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 366087 Page 1 of 1
ONE CIVIC SQUARE TIMOTHY WITHERS
CARMEL, INDIANA 46032 1122 CLAIRBORNE COURT CHECK AMOUNT: $44.00
INDIANAPOLIS IN 46280 CHECK NUMBER: 207276
CHECK DATE: 3/13/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 44.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 794836
Carmel o Clay Payment Date: 03/05/12
Household 7584
ParksAecreatron
I I..,
Morton Community Center} p b 2011 Timothy Withers Hm Ph: (317)581 -0376
Carmel IN 46032 1122 Clairborne Ct Wk Ph: (317)
Indianapolis IN 46280 Cell Ph: (317)319 -7390
edelweiss77 @msn.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 44.00
Enrollee Name: Benjamin Withers Fees Tax Discount Prey Paid Cur Paid Amount Due
Activity Number: 326323 -02 Fitness Fun 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 02/27/2012 (Cancelled)
Primary Instructor: Motions Inc
Class Location: Gymnasium B Class Dates: 03/06/2012 to 03/27/2012
Monon Community Cntr 5:OOP to 5:45P
Tu
Carmel, IN 46032 Scheduled Sessions: 4
(317)848 -7275
Cancel Reason: low enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 03/05/12 09:38:02 by LVA FEES CHANGED ON CANCELLED ITEMS 44.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 44.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 44.00 Made By REFUND FINAN With Reference low enrollment
All refunds are subject to State.Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issu T No cash or credit card refunds.
3s z
Authorized Slgnatur Date I Authorized Signature D to
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: //2011 cpry .theregistrationsystem.com /en /l 033!
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.
Withers, Timothy Terms
1122 Ciairborne Ct Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3!5112 794836 Refund 44,00
Totai7 44.00
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.
Withers, Timothy Allowed 20
1122 Clairborne Ct
Indianapolis, IN 46280
In Sum of$
44.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1 096 -42 794836 4358400 44.00 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
8 -Mar 2012
Signature
44.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund