227022 12/11/2013 CITY OF CARMEL, INDIANA VENDOR: 367790 Page 1 of 1
1 � ONE CIVIC SQUARE ZSOLT KESZTHELYI CHECK AMOUNT: $15.00
CARMEL, INDIANA 46032 5621 HYACINTH AVE
INDIANAPOLIS IN 46259 CHECK NUMBER: 227022
CHECK DATE: 12/11/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 15 . 00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 1177436
Carmel e Clay Payment Date: 12/02/13
Household#: 56317
Parks& ecr-ealtivlr�
Monon Community Center FD """ Zsolt Keszthelyi Hm Ph: (317)869-9373
Carmel IN 46032 3 2013 5621 Hyacinth Ave
Cell Ph:
Indianapolis IN 46259
Phone: (317)848-7275 zsoltxyz @gmail.com
Fed Tax ID#35-6000972 -- -_-=-
Enrollment Details
ROSTER CHANGE -Refund Of 15.00
Enrollee Name: ZSOIt KeSzthelyi Fees+Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 237006-01 MCC Fall Open 2013 71.00 0.00 71.00 0.00 0.00
Enrollment Date: 10116/2013 (Enrolled)
Class Location: Gymnasium A Class Dates: 11/09/2013 to 11/09/2013
Monon Community Cntr 8:OOA to 8:OOP
Sa
Carmel, IN 46032 Scheduled Sessions: 1
(317)848-7275
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 12/02/13 @ 15:51:01 by MML FEES ADJUSTED ON CHANGED ITEMS(+) 15.00-
;NET::'AMOUNT-FROM;,CHANGED,;ITEMS :;,15:00
T,OTALAMOUNT`REFUNDED. 15:00:^
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 15.00 Made By=_>REFUND FINAN With Reference=_>cancelled 1 event
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
issued.
- /Z � /3 133 ►3
Authorized Signature 'Date Aut rized 1'nature Date
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.
Keszthelyi, Zsolt Terms
5621 Hyacinth Ave Date Due
Indianapolis, IN 46259
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/ 1177436 Refund $ 15.00
Total $ 15.00
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.
Keszthelyi, Zsolt Allowed 20
5621 Hyacinth Ave
Indianapolis, IN 46259
In Sum of$
$ 15.00
ON ACCOUNT OF APPROPRIATION FOR
109 -MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-50 1177436 4358400 $ 15.00 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
6-Dec 2013
Signature
$ 15.00 Accounts Payable Coordinator
Cost distribution ledger classification if I Title
claim paid motor vehicle highway fund