216907 01/29/2013 CITY OF CARMEL, INDIANA VENDOR: 366911 Page 1 of 1
ONE CIVIC SQUARE JACQUELINE TOOLEY
;`. CARMEL, INDIANA 46032 1216 N CLARIDGE WAY CHECK AMOUNT: $85.00
a�d� CARMEL IN 46032 CHECK NUMBER: 216907
CHECK DATE: 1/29/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 85 . 00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 999171
Carmel * Clay Payment Date: 01/21/13
rks&Recrcatoon Household #: 44322
Monon Community Center Jacqueline Tooley Hm Ph: (317)669-2146
Carmel IN 46032 1216 N. Claridge Way
JAN 2 2 2013 ! Carmel IN 46032 Cell Ph:(317)565-9731
tooleyhousel2l6@yahoo.com
Phone: (317)848-7275 r
Fed Tax ID#35-6000972 -`=- _. -----------.______�
Enrollment Details
CANCELLATION - Refund Of 85.00
Enrollee Name: Jennifer Tooley Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 336116-01 Hip Hop 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 12/03/2012 (Cancelled)
Primary Instructor: Dance Class Studio
Class Location: Dance Studio B . Class Dates: 01A 9/2013 to 03/23/2013
Monon Community Cntr 12:15P to 12:45P
Sa
Carmel, IN 46032 Scheduled Sessions: 10
(317)848-7275
Cancel Reason: low enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 01/21/13 @ 16:14:37 by LVA FEES CHANGED ON CANCELLED ITEMS(+) 85.00-
NET AMOUNT FROM CANCELLED ITEMS 85:00
TOTAL AMOUNT REFUNDED 85.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 85.00 Made By==>REFUND FINAN With Reference==>low enrollment
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issu
112,1
Authorized Signat/ ' Xutholi Si ature /Date(
Escape Day Passes are non-refundable.
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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.
Tooley, Jacqueline Terms
1216 N. Claridge Way Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/21/13 999171 Refund $ 85.00
Total $ 85.00
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.
Tooley, Jacqueline Allowed 20
1216 N. Claridge Way
Carmel, IN 46032
In Sum of$
$ 85.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-42 999171 4358400 $ 85.00 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
24-Jan 2013
Signature
$ 85.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund