217270 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 363407 Page 1 of 1
gf� ONE CIVIC SQUARE SOWMYA NATARAJAN
CARMEL, INDIANA 46032 14075 MAGIC STALLION DRIVE CHECK AMOUNT: $150.00
CARMEL IN 46032 CHECK NUMBER: 217270
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 150 . 00 REFUND
p ---------------
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ACTIVITY REFUND RECEIPT
Carmel Clay Receipt# 999996
���&tecre� eon Payment Date: 01/24/13
�ECF,T' 7 Household#: 29124
Monon Community Center li JAN 2 2013
Carmel IN 46032 S
<, owmya Natara'1 an
— Hm Ph' _
- -----__ 14075 Magic Station Dr. � (317)564 8111
Carmel IN 46032
Phone: (317)848-7275 sowm a97 ahoo.co Cell Ph:
Y @
Fed Tax ID -
Y m
#35 6000972
Enrollment Details
CANCELLATION -
Enrollee Name: Refund Of 80.00
Maanav Rajesh
Activity Number: 335202-02 Lil' Dragon Taekwond E=L+J@" °U Prey
Enrollment Date: 12/03/2012 (Cancelled) 0.00 0.00 ur Pad ° t Due
0.00 0.00 0.00 �
Primary Instructor: Indy Taekwondo Academy
Class Location: Multi-Purpose Room
Monon Community Cntr Class Dates: 01/09/2013 to 02/27/2013
5:15P to 6:OOP
Carmel, IN 46032 W
(317)848-7275 Scheduled Sessions: 8
Cancel Reason: class cancelled by CCPR
CANCELLATION -Refund Of 70.00
Enrollee Name: Maanav Rajesh
Activity Number: 335202-05 Lil' Dragon Taekwond S+Tax
Enrollment Date: Sc C Paid Amount 0
12/03/2012 (Cancelled) 0.00 0.00 0.00
0.00 o.00
Primary Instructor: Indy Taekwondo Academy
Class Location: Multi-Purpose Room
Monon Community Cntr Class Dates: 03/06/2013 to 04/24/2013
5:15P to 6:OOP
Carmel, IN 46032 W
(317)848-7275 Scheduled Sessions: 7
Skip Days 04/03/2013
Cancel Reason: class cancelled by CCPR
Processed on 01/24/13 @ 11:18:05 by MJN PREVIOUS NET HOUSEHOLD BALANCE 0.00
FEES CHANGED ON CANCELLED ITEMS(+)
150.00- I
NET AMOUNT FROM CANCELLED ITEMS
150.00-
7 5 j �O O TOTAL AMOUNT REFUNDED
l 7 150.00
NEW NET HOUSEHOLD BALANCE
0.00
Refund of=_> 150.00 Made B >
Y== REFUND FINAN With Reference=_>class cancld by ccpr
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds
will be
issued,
it
Page# 1 of 2
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Carrnei @ Clay ACTIVITY REFUND RECEIPT *Ntv" f< �4
ParksAecreatio
n
Receipt#
99
Payment 9996
Date:
01/24/2013
013
Household#:
II 29124
Authorized Signature —Tate '
te r �
Au h ize btignature 12
Y ate
Escape Day Passes are non-refundable.
Page# 2 of 2
3
Inn,I
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.
Natarajan, Sowmya Terms
14075 Magic Stalion Dr Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/24/13 999996 Refund $ 150.00
Total $ 150.00
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
Allowed 20
iN 46032
In Sum of$
$ 150.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-32 999996 4358400 $ 150.00 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
7-Feb 2013
signature
$ 150.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund