183133 03/16/2010 CITY OF CARMEL, INDIANA VENDOR: 363962 Page 1 of 1
Q� ONE CIVIC SQUARE KRIS BUCKLES CHECK AMOUNT: $63.00
CARMEL, INDIANA 46032 1524 SPRINGMILL BLVD
CARMEL IN 46032 CHECK NUMBER: 183133
CHECK DATE: 3/1612010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 396923 63.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 396923
Payment Date: 03/10/10
Household 8472
Monon Center Kris Buckles Hm Ph: (317)816 -0791
Carmel IN 46032 1524 Springmill Blvd. Wk Ph: (317)432 -5511
Carmel IN 46032 Cell Ph: (317)432 -5511
amy.m.buckles@gmaii.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
v
Pass Details
CANCELLATION Refund Of 63.00
Pass Holder: Amy Buckles Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: KZ 50 Visit (M Z50), #61343 12.00 0.00 12.00 0.00 0.00
Valid Dates: 12/21/2009 to 12/31 /2099 Pass Cancellation)
Pass Visit Into: Number of Visits: 42
Cancel Reason: prorated request
G/L Code De Account Nu mber Cst Cntr Description_ Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 63.00 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 03/10/10 15:22:44 by LVA FEES CHANGED ON CANCELLED ITEMS 63.00
NET AMOUNT FROM CANCELLED ITEMS fi3.00-
TOTAL AMOUNT. 'REFUNDED`,'
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 63.00 Made By REFUND FINAN With Reference prorated request
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
i.ss d. No cash or credit card refunds,
3 o ho 1�� [h o
Authorized 46 ture d ate Autho zed Signature Date
bi f� -5,1:5 oq �oa MAk ,f
W o ralcl4 UC4- BY
Page 1
ACCOUNTS PAYABLE VOUCHER
Y 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.
Terms
Buckles, Kris
1524 Springmill Blvd Date Due
Carmel, IN 46032
Invoice Invoice Description
or note attached invoice 63.00
s) or bill(s)) Amount
Date Number
3/10/10 396923 Refund
Total 63.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Buckles, Kris Allowed 20
1524 Springmill Blvd
Carmel, IN 46032
In Sum of
63.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -41 396923 4358400 63.00 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
11 -Mar 2010
Signature
63.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund