HomeMy WebLinkAbout221846 07/11/2013 CITY OF CARMEL, INDIANA VENDOR: 367265 Page 1 of 1
ONE CIVIC SQUARE MARY BETH STAUB
CARMEL INDIANA 46032 533 E COLUMBINE LANE CHECK AMOUNT: $52.50
,
WESTFIELD IN 46074 CHECK NUMBER: 221846
CHECK DATE: 7/11/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 52 . 50 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 1087096
k-larme, ) Clay Payment Date: 07/01/13
Clay
Par sAecreation Household #: 54212
A
Monon Community Center JUL 2 2013 MaryBeth Staub Hm Ph: (317)414-7612
Carmel IN 46032 533 E Columbine Lane
Westfield IN 46074 Cell Ph:
marybeth_staub @yahoo.com
Phone: (317)848-7275 -
Fed Tax ID #35-6000972
Enrollment Details
CANCELLATION - Refund Of 52.50
Enrollee Name: Elayna Staub Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476001-15 Play On 52.50 0.00 52.50 0.00 0.00
Enrollment Date: 06/13/2013 (Cancelled)
Class Location: Creekside Middle Sch Class Dates: 07/01/2013 to 07/03/2013
Creekside Middle Sch 7:OOA to 6:OOP
3525 W. 126th Street M,Tu,W
Carmel, IN 46032 Scheduled Sessions: 3
(317)848-7275
Skip Days 07/04/2013
Cancel Reason: change in plans
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/01/13 @ 12:02:12 by BJJ FEES CHANGED ON CANCELLED ITEMS(+) 52.50-
NET AMOUNT FROM CANCELLED ITEMS 52.50
TOTAL AMOUNT REFUNDED 52.50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 52.50 Made By=_>REFUND FINAN With Reference=_>
Ali refunds are Subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
Adthodzedlgianature Date Authorized Signature Date
Escape Day Passes are non-refundable.
rj
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.
Staub, MaryBeth Terms
533 E Columbine Lane Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)) Amount
711/13 1087096 Refund $ 52.50
Total $ 52.50
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
Voucher No. Warrant No.
Staub, MaryBeth Allowed 20
533 E Columbine Lane
Westfield, IN 46074
In Sum of$
$ 52.50
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITLE AMOUNT
I
1082-11 1087096 4358400 $ 52.50 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
rec-eived except
10-Jul 2013
L
Signature
$ 52.50 _ Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund