210935 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 366418 Page 1 of 1
ONE CIVIC SQUARE PATRICIA LONG CHECK AMOUNT: $156.00
,ro CARMEL, INDIANA 46032 10722 KNIGHTSBRIDGE LANE
FISHERS IN 46037 CHECK NUMBER: 210935
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 875584 39 . 00 REFUNDS AWARDS & INDE
1096 4358400 877196 117 . 00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 875584
Carmel l * lay Payment Date: 06/28/12
,y Household #: 36482
Parks&Recreation
Monon Community Center F,�, CEWED Patricia Long Hm Ph: (317)585-8101
Carmel IN 46032 10722 Knightsbridge Lane
JUL 0 2 2012 Fishers IN 46037 Cell Ph:
tricialong @ comcast.net
Phone: (317)848-7275 .Fed Tax ID#35-6000972
Enrollment Details
ROSTER CHANGE - Refund Of 39.00
Enrollee Name: Alex Long Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 126100-02 IUPUI Jaguars Basket 156.00 0.00 156.00 0.00 0.00
Enrollment Date: 06/14/2012 (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 06/28/12 @ 15:33:23 by LVA FEES ADJUSTED ON CHANGED ITEMS(+) 39.00-
NET AMOUNT FROM CHANGED ITEMS 39.00
TOTAL AMOUNT REFUNDED 39.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 39.00 Made By==>REFUND FINAN With Reference==>prorated refund
All ref s are subject to State Board of Accounts claim procedure and may take 4-6 weeks to process. A check will be
issu A,Ao cash or credit card refunds.
41Z (0 29 IL
Authorized Sign a Date ut hfAz ed nature 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:H2011 cpry.theregistrationsystem.com/en/1033!
DAY PASSES ARE NON-REFUNDABLE
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YAJ Q 1 �1T W I \}`J Page# 1 of 1
ACTIVITY REFUND RECEIPT
Receipt# 877196
Carmel * Clay Payment Date: 06/29/12
Household #: 36482
ParksAecreation +r;FT\7ED
JUL 022012
Monon Community Center Patricia Long Hm Ph: (317)585-8101
Carmel IN 46032 F0 hers INKnightsbridge Lane Cell Ph:
tricialong@comcast.net
Phone: (317)848-7275
Fed Tax ID#35-6000972
Enrollment Details
ROSTER CHANGE - Refund Of 117.00
Enrollee Name: Alex Long Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 126100-02 IUPUI Jaguars Basket 39.00 0.00 39.00 0.00 0.00
Enrollment Date: 06/14/2012 (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 06/29/12 @ 15:03:20 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
issu No cash or credit card refunds.
Authorized Signat a Dat h ize S' nature 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!
DAY PASSES ARE NON-REFUNDABLE
Oq (0— r �_ 1 �qoo
e 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
Long, Patricia Date Due
10722 Knightsbridge Lane
Fishers, IN 46037
Invoice ;Number oice Description
Date (or note attached invoice(s) or bill(s)) Amount
6/28/12 5584 Refund $ 39.00
6/29/12 877196 Refund $ 117.00
Total $ 156.00
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
Long, Patricia
10722 Knightsbridge Lane
Fishers, IN 46037 In Sum of$
$ 156.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
875584 4358400 $ 39.00. 1 hereby certify that the attached invoice(s), or
1096-42 877196 4358400 $ 117.00 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
/),�//Ymm)
Signature
$ 156.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund