HomeMy WebLinkAbout223041 08/13/2013 ��. CITY OF CARMEL, INDIANA VENDOR: 367435 Page 1 of 1
ONE CIVIC SQUARE MOHITOSH KEJRIWAL
CARMEL, INDIANA 46032 375 BROWN STREET APT 418 CHECK AMOUNT: $52.00
WEST LAYFAYETTE IN 47906 CHECK NUMBER: 223041
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 52 . 00 PARKS REFUND
ACTIVITY REFUND RECEIPT
Carmel Clay Receipt# 11
� Payment Date: 07/30/13 30/13
Nirks&Recreation Household#: 54946
Monon Community Center Mohitosh Kejriwal Hm Ph: (765)426-3895
Carmel IN 46032 375 Brown Street Apr. 418
West Lafayette IN 47906 Cell Ph:
mohitoshk @gmail.com
Phone: (317)848-7275
Fed Tax ID #35-6000972
Enrollment Details
CANCELLATION - Refund Of 52.00
Enrollee Name: MOhitOSh Kejriwal Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 137006-01 MCC Summer Open 2013 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 07/24/2013 (Cancelled)
Class Location: Gymnasium A Class Dates: 08/03/2013 to 08/03/2013
Monon Community Cntr 8:OOA to 8:OOP — -
Sa ;l
Carmel, IN 46032 Scheduled Sessions: 1
(317)848-7275 JUL 3 12013
i
Cancel Reason: low enrollment
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/30/13 @ 12:40:00 by MML FEES CHANGED ON CANCELLED ITEMS(+) 52.00-
NET AMOUNT FROM CANCELLED ITEMS 52.00
TOTAL AMOUNT REFUNDED 52.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 52.00 Made By=_>REFUND FINAN With Reference=_>low enrollment
All refunds are subject to State Board of Accounts procedures ankA take 4. e s to process. No cash refunds will be
issued.
Authorized Signature Date h ized nature D to
f dol(,. 50' q 3591400
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.
Kejriwal, Mohitosh Terms
375 Brown Street Apt. 418 Date Due
West Lafayette, IN 47906
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/30/13 1118897 Refund S 52.00
Total $ 52.00
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
20_
Clerk-Treasurer
Voucher No. Warrant No.
Kejriwal, Mohitosh Allowed 20
375 Brown Street Apt. 418
West Lafayette, IN 47906
In Sum of$
$ 52.00
ON ACCOUNT OF APPROPRIATION FOR
109 - MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-50 1118897 4358400 $ 52.00 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
8-Aug 2013
Signature
$ 52.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund