221187 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 367207 Page 1 of 1
ONE CIVIC SQUARE MARTHA PAULEY
CARMEL, INDIANA 46032 13686 STONE DRIVE CHECK AMOUNT: $40.00
CARMEL IN 46032 CHECK NUMBER: 221187
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 40 . 00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 1064191
Carmel Payment Date: 06/13/13
* Clay
Parks&recreation Household #: 44295
IZEr�._ ,T-T 0:j
Monon Community Center JUN 17 2013 Martha Pauley Hm Ph: (317)853-6401
Carmel IN 46032 13686 Stone Drive
Carmel IN 46032 Cell Ph:(901)218-2555
curveofgold @gmail.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Enrollment Details
Enrollee Name: Nate Pauley Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 135111-03 Pee Wee Golf 85.00 0.00 0.00 85.00 0.00
Enrollment Date: 06/13/2013 (Enrolled -Transfer from 476010-04 (Skyhawks))
Class Location: Plum Creek Golf Club Class Dates: 08/26/2013 to 08/29/2013
Plum Creek Golf Cour 9:OOA to 10:OOA
12401 Lynnwood Blvd. M,Tu,W,Th
Carmel, IN 46033 Scheduled Sessions: 4
(317)848-7275
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/13/13 @ 11:14:14 by MJN FEES ADJUSTED ON CHANGED ITEMS(+) 40.00-
�11_ 66 NET AMOUNT FROM CHANGED ITEMS 40.00-
TOTAL AMOUNT REFUNDED 40.00
log6 , 3z .
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 40.00 Made By=_>REFUND FINAN With Reference=_>check refund
Payment of=_> 85.00 Made By=_> Activity Registration Credit Balance
All refunds are subject to State Board of Accounts procedures and may take -6 we to process. No cash refunds will be
issued.
Authorized Signature Date Aut on ed Sig t r D to
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.
Pauley, Martha Terms
13686 Stone Drive Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/13/13 1064191 Refund $ 40.00
Total $ 40.00
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
it
Voucher No. Warrant No.
Pauley, Martha Allowed 20
13686 Stone Drive
Carmel, IN 46032
In Sum of$
$ 40.00
ON ACCOUNT OF APPROPRIATION FOR _
109 - Monon Center
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITLE AMOUNT
1096-32 1064191 4358400 $ 40.00 1 hereby certify that the attached invoice(s), or
bi!I(s) is (are)true and correct and that the
materials or services itemized thereon for
w!iich charge is made were ordered and
received except
17-Jun 2013
Signature
$ 40.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund