223088 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 367437 Page 1 of 1
ONE CIVIC SQUARE TRACI MIZRAHI CHECK AMOUNT: $11.50
CARMEL,INDIANA 46032 12923 TRADD ST 2C
CARMEL IN 46032 CHECK NUMBER: 223088
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 11 . 50 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt# 1115325
Carmel Clay Payment Date: 07/25/13
J
ParksAecreatian Household #: 53348
C EElV�I�
Monon Community Center Traci Mizrahi Hm Ph: (203)918-0668
Carmel IN 46032 JUL 2 9 2013 12923 Tradd St 2C
Carmel IN 46032 Cell Ph:(203)918-0668
tmizrahi@yahoo.com
Phone: (317)848.7275 By:
Fed Tax ID#35-6000972
Enrollment Details
ROSTER CHANGE- Refund Of 11.50
Enrollee Name: Traci Mizrahi Fees+Tax Discount Prey Paid Cur Paid Amount Due
Activity Number: 137021-01 Tan 80.50 0.00 80.50 0.00 0.00
Enrollment Date: 05/05/2013 Enrolled)
Primary Instructor: Dance Class Studio
Class Location: Dance Studio B Class Dates: 06/04/2013 to 07/30/2013
Monon Community Cntr 7:15P to 8:OOP
Tu
Carmel, IN 46032 Scheduled Sessions: 8
(317)848-7275
Skip Days 07/02/2013
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/25/13 @ 15:24:47 by MML FEES ADJUSTED ON CHANGED ITEMS(+) 11.50-
NET AMOUNT.FROM CHANGED.ITEMS 11.50
TOUL:AMdUNT::REFUNDED 11'50:
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 11.50 Made By(—=> NA N Wi Reference==>cancelled 1 session
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
�,� 3
AuthAedSignature D to Authorized Signature Date
10%, '50, 435M'D
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.
Mizrahi, Traci Terms
12923 Tradd St 2C Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/25/13 1115325 Refund $ 11.50
Total $ 11.50
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
120
Clerk-Treasurer
Voucher No. Warrant No.
Mizrahi, Traci Allowed 20
12923 Tradd St 2C
Carmel, IN 46032
In Sum of$
$ 11.50
ON ACCOUNT OF APPROPRIATION FOR
109 - MCC
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1096-50 1115325 4358400 $ 11.50 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
materials or services iternized thereon for
which charge is made were ordered and
received except
8-Aug 2013
Signature
$ 11.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund