219288 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 367084 Page 1 of 1
ONE CIVIC SQUARE SHELIA COURCHAINE
` CARMEL, INDIANA 46032 1531 BROOK MILL COURT CHECK AMOUNT: $72.00
'+ CARMEL IN 46032
CHECK NUMBER: 219288
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 72 . 00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 1033715
Carmel @ Clay Payment Date: 04/10/13
Household #: 23001
ParksAccreatoon
Monon Community Center APR 12 2013 Sheila Courchaine Hm Ph: (317)844-3443
Carmel IN 46032 1531 Brook Mill Ct Wk Ph: (317)347-0533
BY: _ Carmel IN 46032 Cell Ph:(317)525-1145
scourch576@aol.com
Phone: (317)848-7275
Fed Tax ID #35-6000972
Enrollment Details
CANCELLATION - Refund Of 72.00
Enrollee Name: Steve Courchaine Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 337036-01 Introduction to the 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 01/16/2013 (Cancelled)
Primary Instructor: Eric Anderson
Class Location: Banquet Room C Class Dates: 04/10/2013 to 04/24/2013
Monon Community Cntr 6:OOP to 7:30P
W
Carmel, IN 46032 Scheduled Sessions: 3
(317)848-7275
Cancel Reason: low enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 04/10/13 @ 16:12:43 by MML FEES CHANGED ON CANCELLED ITEMS(+) 72.00-
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 72.00"
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 72.00 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
issued.
01 #'" `"ll10 13
Authorized Signature Date Auto zed SVnature Date
I()16.155a . q 3 �Tll
Escape Day Passes are non-refundable.
Page# 1 of 1
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.
Courchaine, Sheila Terms
1531 Brook Mill Ct Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/10/13 1033715 Refund $ 72.00
I
Total $ 72.00
I 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.
Courchaine, Sheila Allowed 20
1531 Brook Mill Ct
Carmel, IN 46032
In Sum of$
$ 72.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITLE AMOUNT
1096-50 1033715 4358400 $ 72.00 1 hereby certify that the attached invoice(s), or
bil!(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
19-Apr 2013
Signature
$ 72.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund