210761 07/17/2012 ��. CITY OF CARMEL, INDIANA VENDOR: 366412 Page 1 of 1
ONE CIVIC SQUARE RADHIKA BLEVIS-BAL CHECK AMOUNT: $66.00
CARMEL, INDIANA 46032 6350 BLACK HEAT CIRCLE
MASON OH 45040 CHECK NUMBER: 210761
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 882257 66 . 00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 882257
rmel * Clair Payment Date: 07/03/12
Household#: 47736
rksAecreation
Monon Community Center -h Radhika Blevis-Bal Hm Ph: (314)954-0289
Carmel IN 46032 7� p �j �L � (� 41 1-6 PennsyLuana Wk Ph: (317)277-7738
` lytdianapahs 269 Cell Ph:
Phone: (317)848-7275 mrs.r.b.18 @gmail.com����
Fed Tax ID#35-6000972
Enrollment Details
CANCELLATION - Refund Of 66.00
Enrollee Name: Benjamin Blevis Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476001-26 Vacation Station 66.00 0.00 66.00 0.00 0.00
Enrollment Date: 06/25/2012 (Cancelled)
i
Class Location: Carmel Middle School Class Dates: 07/02/2012 to 07/06/2012
Carmel Middle School 7:OOA to 6:OOP
300 S Guilford Rd M,Tu,Th,F
Carmel, IN 46032 Scheduled Sessions: 4 � �T
(317)848 7275
V � M JUL 06 2012
Cancel Reason: not using camp wee
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/03/12 @ 15:06:28 by JAB FEES CHANGED ON CANCELLED ITEMS(+) 66.00-
0 NET AMOUNT FROM CANCELLED ITEMS 66.00-
`� TOTAL AMOUNT REFUNDED 66.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 66.00 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
i d. No cash or credit card refunds.
uthorize ature 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 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:H2011cprv.theregistrationsystem.com/en/l 033!
DAY PASSES ARE NON-REFUNDABLE
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.
Blevis-Bal, Radhika Terms
6350 Black Heat Cir. Date Due
Mason, OH 45040
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/3/12 882257 Refund $ 66.00
Total—I $ 66.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Blevis-Bal, Radhika Allowed 20
6350 Black Heat Cir.
Mason, OH 45040
In Sum of$
$ 66.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-1 882257 4358400 $ 66.00 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
12-Jul 2012
Signature
$ 66.00_ Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund