185971 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 364152 Page 1 of 1
ONE CIVIC SQUARE WILLIAM SULLIVAN
CHECK AMOUNT: $159.50
CARMEL, INDIANA 46032 3743 MONTY CIRCLE
CARMEL IN 46032 CHECK NUMBER: 185971
CHECK DATE: 5/26/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 418023 159.50 REFUNDS AWARDS INDE
GLOBAL REFUND RECEIPT
Receipt 418023
Payment Date: 05/06/10
Household 20999
Monon Center William Sullivan Hm Ph. (317)879-9985
Carmel IN 46032 3743 Monty Circle
Carmel IN 46032 Cell Ph: (317)531-2693
Phone: (317)848 -7275 wjsullivan @aol.com
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 159.50
Pass Holder: Lori Sullivan Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: UnGrpFit Annual (M UGFA), #87161 115.50 0.00 0.00 115.50 0.00
Valid Dates: 11/09/2009 to 11/09/2010 Pass Cancellation)
Cancel Reason: time conflict
G/L Code Description Account Number Cst Cntr Description _Ac count Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 159.50 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 05/06/10 15:12:05 by TCP FEES CHANGED ON CANCELLED ITEMS 275.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 115.50
"NET AMOUNT'F,ROM,CANCELLED,IT,EMS';
TOTAL: AMOUNT:REFUNDED
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 159.50 Made By REFUND FINAN With Reference �conffict
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No cash or credit card refunds.
5h
A thorized Signature Date Authorized Signature Date
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.
Sullivan, William Terms
3743 Monty Circle Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
516110 418023 Refund 159.50
Total 159.50
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 T
Clerk- Treasurer
Voucher No. Warrant No.
Sullivan, William Allowed 20
3743 Monty Circle
Carmel, IN 46032
In Sum of
159.50
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept
1096 -22 418023 4358400 159.50 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
20 -May 2010
Signature
159.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund