222614 07/30/2013 CITY OF CARMEL, INDIANA VENDOR: 367319 Page 1 of 1
ONE CIVIC SQUARE NICOLE WASHINGTON
CARMEL, INDIANA 46032 4826 LONG IRON DRIVE CHECK AMOUNT: $150.00
� ? INDIANAPOLIS IN 46235
CHECK NUMBER: 222614
CHECK DATE: 7/30/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 150 . 00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 1092914
fll �� Payment Date: 07/10/13
, �-r-�. T�� Household #: 54335
Parks i�rye creation RTC`�.
JILL
Monon Community Center Nicole Washington Hm Ph: (317)855-7522
Carmel IN 46032 j. ;''-' `__ —1 4826 Long Iron Dr. Wk Ph: (317) -
Indianapolis IN 46235 Cell Ph:
Phone: (317)848-7275 nlwashington @sbcglobal.net
Fed Tax ID#35-6000972
Enrollment Details
CANCELLATION -Refund Of 150.00
Enrollee Name: Morgan Mark Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 138050-02 Adaptive Swim Lesson 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 06/18/2013 (Cancelled)
Class Location: Indoor Leisure Pool Class Dates: 06/01/2013 to 06/30/2013
Monon Community Cntr 12:00A to 12:OOA
M,Tu,W,Th,F,Sa
Carmel, IN 46032 Scheduled Sessions: 25
(317)848-7275
Cancel Reason: Not a good fit
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/10/13 @ 10:38:54 by BNT FEES CHANGED ON CANCELLED ITEMS(+) 150.00-
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 150.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 150.00 Made By==>REFUND FINAN With Reference=_>
All refunds are subject to State Board of Accounts procedu4andma process. No cash refunds will be
issued.
7 �o _-
Authorized Signatur� Date ` Datc/
\b% - --Ab - fig
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.
Washington, Nicole Terms
4826 Long Iron Dr Date Due
Indianapolis, IN 46235
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/10/13 1092914 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
Voucher No. Warrant No.
Washington, Nicole Allowed 20
4826 Long Iron Dr
Indianapolis, IN 46235
In Sum of$
$ 150.00
ON ACCOUNT OF APPROPRIATION FOR
109 - MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept ept#
1096-70 1092914 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
25-Jul 2013
Signature
$ 150.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund