223210 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 367441 Page 1 of 1
ONE CIVIC SQUARE DIANE JOHNSON SPECK
i Q � CHECK AMOUNT: $11.50
CARMEL, INDIANA 46032 12672 PLUM CREEK BLVD
CARMEL IN 46033 CHECK NUMBER: 223210
CHECK DATE: 8/1312013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 11 . 50 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt# 1115295
Carmel 9 Clay Payment Date: 07/25/13
Parks Aecreation Household #: 15319
Monon Community Center J EUL M[3 i Diane Johnson Speck Hm Ph: (317)843-9025
Carmel IN 46032 12672 Plum Creek Blvd Wk Ph: (317)
Carmel IN 46033 Cell Ph:(317)
Phone: (317)848-7275 -_
_f
Fed Tax ID#35-6000972
Enrollment Details
ROSTER CHANGE-Refund Of 11.50
Enrollee Name: Diane Johnson Speck F q+Tax Discount Prey Paid Our Paid Amount Due
Activity Number: 137021-01 Tap 80.50 0.00 80.50 0.00 0.00
Enrollment Date: 04/0112013 (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 @ 15.14:54 by MML FEES ADJUSTED ON CHANGED ITEMS(+) 11.50-
':NET.AM0UNT-FROM CHANGED ITEMS` :.111
l.T0TAL:AM0IJNT AEPUNDED , 11:50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 11.50 Made By_=>REFUND FINAN With Reference=_>
All refunds are subject to State Board of Ac=jnts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
Authorized Signature Date Authorized Signature Date
1104( 150, �3_5�eY66
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.
Speck, Diane Johnson Terms
12672 Plum Creek Blvd Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/25/13 1115295 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
20_
Clerk-Treasurer
Voucher No. Warrant No.
Speck, Diane Johnson Allowed 20
12672 Plum Creek Blvd
Carmel, IN 46033
In Sum of$
$ 11.50
ON ACCOUNT OF APPROPRIATION FOR
109 - MCC
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITLE AMOUNT
1096-50 1115295 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 itemized 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