222885 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 367433 Page 1 of 1
ONE CIVIC SQUARE MATTHEW CLAYMON
CARMEL, INDIANA 46032 3509 SEDGEMOOR CIRCLE CHECK AMOUNT: $175.00
CARMEL IN 46032 CHECK NUMBER: 222885
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 175 . 00 REFUNDS AWARDS & INDE
GLOBAL REFUND RECEIPT
Receipt# 1119274
carme'I Clay Payment Date: 07/31/13
Household #: 12454
P r s&Recrcatidh :AEI
I Etoz T t inr
Monon Community Center Matthew Claymon Hm Ph: (317)844-8200
Carmel IN 46032 10_�LLt_ AL 3509 Sedgemoor Circle
Carmel IN 46032 Cell Ph:(317)557-8520
Phone: (317)848-7275 melanie@claymongroup.com
Fed Tax ID#35-6000972
Enrollment Details
CANCELLATION - Refund Of 87.50
Enrollee Name: Austin ClaymOn Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476008-09 Lead the Way 87.50 0.00 87.50 0.00 0.00
Enrollment Date: 04/09/2013 (Cancelled)
Class Location: Banquet Room BC Class Dates: 07/29/2013 to 08/02/2013
Monon Community Cntr 8:OOA to 5:30P
M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848-7275
Cancel Reason: change in plans
CANCELLATION - Refund Of 87.50
Enrollee Name: lily ClaymOn Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476008-09 Lead the Way 87.50 0.00 87.50 0.00 0.00
Enrollment Date: 04/09/2013 (Cancelled)
Class Location: Banquet Room BC Class Dates: 07/29/2013 to 08/02/2013
Monon Community Cntr 8:00A to 5:30P
M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848-727
Cancel Reason: ange in plans
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/31/13 @ 13:37:22 by BJJ � FEES CHANGED ON CANCELLED ITEMS(+) 175.00-
q�SZq NET AMOUNT,FROM„CANCELLED ITEMS. 1175.00
TOTAL AMOUNT REFUNDED 1.75 00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 175.00 Made y=_>REFUND FINAN With eference=_>
All refun are subject to Sta \ procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
AuAml<ed Signature Date Authorized Signature Date
Page# 1 of 2
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.
Claymon, Matthew Terms
3509 Sedgemoor Circle Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/31/13 1119274 Refund $ 175.00
Total $ 175.00
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.
Claymon, Matthew Allowed 20
3509 Sedgemoor Circle
Carmel, IN 46032
In Sum of$
$ 175.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1082-13 1119274 4358400 $ 175.00 i 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
8-Aug 2013
Signature
$ 175.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund I