223644 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 367506 Page 1 of 1
1,. ONE CIVIC SQUARE NAHLA SHEDID CHECK AMOUNT: $140.00
CARMEL, INDIANA 46032 4114 VERA DR
INDIANAPOLIS IN 46220 CHECK NUMBER: 223644
CHECK DATE: 8/27/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 140 . 00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
� Receipt# 1124293
Carmel o Lila\1' Payment Date: 08/07/13
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Parks&Recreation Household #: 52690
AUG - 5 2013
I
Monon Community Center r�•i Nahla Shedid Hm Ph: (317)897-2928
Carmel IN 46032 - _ _ 4114 Vera Dr Wk Ph: (317)809-6056
Indianapolis IN 46220 Cell Ph:(317)809-6056
remofashionwear2@aol.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Enrollment Details
CANCELLATION - Refund Of 140.00
Enrollee Name: Farah Arafa Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 236101-01 Karate 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 07/08/2013 (Cancelled)
Primary Instructor: Fonseca Martial Arts
Class Location: Multi-Purpose Room Class Dates: 09/09/2013 to 10/23/2013
Monon Community Cntr 5:15P to 6:15P
M,W
Carmel, IN 46032 Scheduled Sessions: 14
(317)848-7275
Cancel Reason: advanced request
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/07/13 @ 13:30:46 by LVA FEES CHANGED ON CANCELLED ITEMS(+) 140.00-
NET AMOUNT FROM CANCELLED ITEMS 140.00-
TOTAL AMOUNT REFUNDED 140.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 140.00 Made By==>REFUND FINAN With Reference==>advanced request
All refyn A are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issue .
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Authorized Signature Date Au o e S' nature ate'
Escape Day Passes are non-refundable.
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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.
Shedid, Nahla Terms
4114 Vera Dr Date Due
Indianapolis, IN 46220
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/7/13 1124293 Refund $ 140.00
Total $ 140.00
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.
Shedid, Nahla Allowed 20
4114 Vera Dr
Indianapolis, IN 46220
In Sum of$
$ 140.00
ON ACCOUNT OF APPROPRIATION FOR
109 - MCC
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITLE AMOUNT
1096-42 1124293 4358400 $ 140.00 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
22-Aug 2013
_
Nehh M WU V
Signature
$ 140.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund