184347 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 364044 Page 1 of 1
ONE CIVIC SQUARE DANIEL JACKSON
CARMEL, INDIANA 46032 2902 HAZEL FOSTER DRIVE CHECK AMOUNT: $150.00
CARMEL IN 46033
a.o�c CHECK NUMBER: 164347
CHECK DATE: 4114/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 406080 150.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 406080
Payment Date: 04/01/10
Household 27078
Monon Center Daniel Jackson Hm Ph: (317)571 -8196
Carmel IN 46032 2902 Hazel Foster Drive
carmel IN 46033 Cell Ph:
ddj48236@yahoo.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 120.00
Enrollee Name: Devon Jackson Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 196481 -01 Digital Kidz 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 05/29/2009 (Cancelled)
Primary Instructor: Fun2l-earn
Class Location: Banquet Room B Class Dates: 06/09/2009 to 07/14/2009
Monon Center 12:00P to 2:00P
Tu
Carmel, IN 46032 Scheduled Sessions. 6
(317)848 -7275
Cancel Reason: advanced request
G/L Code Description Acco_u_nt_Numbe Cst C ntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 150.00 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 CREDIT HOUSEHOLD BALANCE 30.00
Processed on 04/01/10 18:21:29 by LV D HE T I I W L 5 1 11l M FEES CHANGED ON CANCELLED ITEMS 120.00
APR U f, 2010 I NET AMOUNT FROM CANCELLED ITEMS 120.00
HH BALANCE APPLIED TO THIS RECEIPT 30.00
Iffy a TOTAL AMOUNT REFUNDED 150.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 150.00 Made By REFUND FINAN With Reference advanced request
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
iss o cash or credit.-R refunds.
d 16
A u NC e Signa r Da e Authorized Signature Date
V Y A V 1
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.
Jackson, Daniel Terms
2902 Hazel Foster Drive Date Due
Carmel, IN 46033
Invoice Invoice Description
Amount
Date Number (or note attached invoice(s) or bill(s))
150.00
411!10 406080 Refund
Total 150.00
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.
Jackson, Daniel Allowed 20
2902 Hazel Foster Drive
Carmel, IN 46033
In Sum of
150.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -42 406080 4358400 150.00 1 hereby certify that the attached invoice(s), or
bill(s) (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
8 -Apr 2010
fA 4 '1& 1 M 1 1V V I
Signature
150.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund