213306 10/09/2012 *f CITY OF CARMEL, INDIANA VENDOR: 366573 Page 1 of 1
`7 ONE CIVIC SQUARE NATALIE MILLER CHECK AMOUNT: $27.00
CARMEL, INDIANA 46032 9410 BENCHVIEW DRIVE
INDIANAPOLIS IN 46240
CHECK NUMBER: 213306
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 27 . 00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Carmel � lay Receipt# 954135
Payment Date: 09/28/12
Nrks&Recreation Household#: 37340
G"^ y'' ' TI ?(� Natalie Miller
Monon Community Center ,_
Carmel IN 46032 9410 Benchview Drive
OCT 0 ]< 2012 Indianapolis IN 46240 Cell Ph:(574)238-4525
miller.natalie13 @gmail.com
Phone: (317)848-7275 -
Fed Tax ID#35-6000972 !;
Enrollment Details
CANCELLATION - Refund Of 27.00
Enrollee Name: Natalie Miller Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 207800-04 Community CPR-Adult 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 09/21/2010 (Cancelled)
Primary Instructor: CCPR Staff
Class Location: West Park Field 7 Class Dates: 10/26/2010 to 10/28/2010
West Park 5:OOP to 8:30P
2700 W. 116th St. Tu,Th
Carmel, IN 46032 Scheduled Sessions: 2
(317)848-7275 (1
Cancel Reason: class cancelled — ZOI O CkQS$– W evev 1r2C21v QO� q 1rt0'
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 09/28/12 @ 13:23:57 by MML FEES CHANGED ON CANCELLED ITEMS(+) 27.00-
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT REFUNDED 27.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 27.00 Made By==>REFUND FINAN With Reference=_>class cancelled
All refunds are subject to State Board of Accounts claim procedure and may take 4-6 weeks to process. A check will be
issued cash or edit rd refunds.
Authorized Signature Date Authori Si ature Date
�o`I�.`DO , 4�6,Rqo C)
Join us at West Park on Saturday, October 6, from 4-9pm, for our Fall Food Festival & Benefit. Local food trucks, restaurants,
and beer/wine vendors compete to be the first ever Fall Food Festival Winner! Try their favorite dishes, relax with the music,
and enjoy a beautiful day at the park with your family. Help children and families participate in department-wide activities;
proceeds will help fund scholarships. $5/person entry fee. There will be an additional cost for food and drink purchases.
Register online at www.carmelclayparks.com.
Escape 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.
Miller, Natalie Terms
9410 Benchview Drive Date Due
Indianapolis, IN 46240
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/28/12 954135 Refund $ 27.00
Total $ 27.00
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.
Miller, Natalie Allowed 20
9410 Benchview Drive
Indianapolis, IN 46240
In Sum of$
$ 27.00
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-50 954135 4358400 $ 27.00 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
4-Oct 2012
Signature
$ 27.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund