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224696 09/25/2013 CITY OF CARMEL, INDIANA VENDOR: 367624 Page 1 of 1 ONE CIVIC SQUARE MICK WIDMEYER CARMEL, INDIANA 46032 2037 E 106TH ST CHECK AMOUNT: $80.00 -`? CARMEL IN 46032 CHECK NUMBER: 224696 CHECK DATE: 912512013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4358400 1149035 80 . 00 PARKS DEPARTMENT REFU ACTIVITY REFUND RECEIPT Receipt# 1149035 of mel * la Payment Date: 09/13/13 J �Ef �'? ? —__ Household #: 24500 Parks&Recreation SEP 1 7 2013 Monon Community Center BY: Mick Widmeyer Hm Ph: (317)507-7282 Carmel IN 46032 0�7 E. 106th Street Wk Ph: (317)848-7282 Carmel IN 46032 Cell Ph: mickwidmeyer@sbcglobal.net Phone: (317)848-7275 Fed Tax ID#35-6000972 Enrollment Details CANCELLATION - Refund Of 80.00 Enrollee Name: Mick Widmeyer Fees+Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 237015-01 Dancing as the Stars 0.00 0.00 0.00 0.00 0.00 Enrollment Date: 08/26/2013 (Cancelled) Primary Instructor: Internationa Talent Academy Class Location: Dance Studio Class Dates: 09/12/2013 to 10/17/2013 Monon Community Cntr 7:30P to 8:30P Th Carmel, IN 46032 Scheduled Sessions: 6 (317)848-7275 Cancel Reason: low enrollment PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 09/13/13 @ 14:19:17 by MML FEES CHANGED ON CANCELLED ITEMS(+) 80.00- NET AMOUNT FROM CANCELLED ITEMS TOTAL AMOUNT AMOUNT REFUNDED 80.00 NEW NET HOUSEHOLD BALANCE 0.00 Refund of=_> 80.00 Made By==>REFUND FINAN With Reference==>low enrollment All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be issued. i 13 Authorized ignature Da e Au ignature Date l©�1�- .�3��4d 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. Widmeyer, Mick Terms 2037 E 106th Street Date Due Carmel, IN 46032 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 9/13/13 1149035 Refund $ 80.00 Total $ 80.00 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. Widmeyer, Mick Allowed 20 2037 E 106th Street Carmel, IN 46032 In Sum of$ $ 80.00 ON ACCOUNT OF APPROPRIATION FOR 109 - MCC PO#or INVOICENO. ACCT#/TITLE AMOUNT Board Members Dept# 1096-50 1149035 4358400 $ 80.00 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 19-Sep 2013 Signature $ 80.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund