210884 07/17/2012 ,F CITY OF CARMEL, INDIANA VENDOR: 366415 Page 1 of 1
ONE CIVIC SQUARE EYAS HATTAB
CARMEL, INDIANA 46032 713 SUFFOLK LANE CHECK AMOUNT: $117.00
.o� CARMEL IN 46032 CHECK NUMBER: 210884
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 879788 117 . 00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 879788
Cal-MCI * Clay Payment Date: 07/02/12
Household #: 13581
Darks&Recreation .:._:
JUL 0 3 2012
Monon Community Center Eyas Hattab Hm Ph: (317)587-1055
Carmel IN 46032 BY: 713 Suffolk Ln. Wk Ph: (317)491-6363
Carmel IN 46032 Cell Ph:(317)258-2523
rhattab @gmail.com
Phone: (317)848-7275
Fed Tax ID #35-6000972
Enrollment Details
ROSTER CHANGE- Refund Of 117.00
Enrollee Name: Sarni Hattab Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 126100-02 IUPUI Jaguars Basket 78.00 0.00 78.00 0.00 0.00
Enrollment Date: 06/12/2012 (Enrolled)
Primary Instructor: Todd Howard
Class Location: Gymnasium -Whole Class Dates: 06/25/2012 to 06/29/2012
Monon Community Cntr 9:OOA to 4:OOP
M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848-7275
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/02/12 @ 09:17:33 by LVA FEES ADJUSTED ON CHANGED ITEMS(+) 117.00-
NET AMOUNT FROM CHANGED ITEMS 117.00
TOTAL AMOUNT REFUNDED 117.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 117.00 Made By==>REFUND FINAN With Reference==>prorated request
All refunds are subject to State Board of Accounts claim procedure and may take 4-6 weeks to process. A check will be
is#d.d. No cash or credit card refunds.
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' Authorized S' ature D to A t nze ignature Da e
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
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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.
Terms
Hattab, Eyas Date Due
713 Suffolk Ln.
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/2/12 879788 Refund $ 117.00
Total $ 117.00
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.
Allowed 20
Hattab, Eyas
713 Suffolk Ln.
Carmel, IN 46032 In Sum of$
$ 117.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-42 879788 4358400 $ 117.00 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
$ 117.00 _ Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund