182993 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 363933 Page 1 of 1
o ONE CIVIC SQUARE SHOAIB SHAFIQUE CHECK AMOUNT: $28.00
CARMEL, INDIANA 46032 3863 HEATHERFIELD COURT
ZIONSVILLE IN 46077 CHECK NUMBER: 182993
CHECK DATE: 3/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 28.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 390697
Payment Date: 02/18/10
Household 10982
Monon Center Shoaib Shafique Hm Ph: (317)873 -5666
Carmel IN 46032 3863 Heathfield Ct.
Zionsville IN 46077 Cell Ph: (317)938 -9838
Phone: (317)848 -7275 shoaibshafique @hotmail.com
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 28.00
Enrollee Name: Adam 5hafique Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 486098 -02 Chess 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 03/0212009 (Cancelled)
Glass Location: Towne Meadow Elem Class Dates: 03/31/2009 to 04/28/2009
Towne Meadow Element 2:45P to 3:45P
10850 Towne Road Tu
Carmel IN 46032 Scheduled Sessions: 5
(317
Cancel Reason: 'c ass cancelled due to low enrollment
G/L Code Descri Acco Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 28.00 DR
The REVENUE account was DEBITED and the CONTROL account was CREDITED on the day of the refund.
Finance will have to DEBIT the CONTROL account for the amounts listed above after the checks have been written to the customers.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 02/18/10 16:37:08 by BJJ FEES CHANGED ON CANCELLED ITEMS 28.00
NET AM0UNT,FROMZANCELLED ITEMS;'''
TOTALuAMOUNT?REFUNDED %1' &00k'
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 28.00 Made By REFUND FINAN With Reference
All refund are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check,}rill be
issued. o cash or credit card refunds.
Au rized Signature Date Authorized Signature Date
qssyyoo C-5 3 9 7 1 7 9 7
A 8� Q FEB 2
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Page 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.
Shafique, Shoaib Terms
3863 Heathfield Ct Date Due
Zionsville, IN 46077
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2118110 390697 Refund 28.00
Total 28.00
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,
Shafique, Shoaib Allowed 20
3863 Heathfield Ct
Zionsville, IN 46077
In Sum of
28.00
ON ACCOUNT OF APPROPRIATION FOR
j 108 ESE
PO# or INVOICE NO. ACCT XTITLE AMOUNT Board Members
Dept
1081 -99 390697 4358400 28.00 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
2010
Signature
28.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund