185950 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 364151 Page 1 of 1
ONE CIVIC SQUARE KAREL SEIDNER CHECK AMOUNT: $107.00
CARMEL, INDIANA 46032 1083 CHURCHMAN AVE
BEECH GROVE IN 46107 CHECK NUMBER: 185950
CHECK DATE: 5/26/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1095 4358400 418965 107.00 REFUNDS AWARDS INDE
FACILITY REFUND RECEIPT
Receipt 418965
Payment Date: 05/10/10
Household 34506
Morton Center Karel Seldner Hm Ph: (317)902 -2365
Carmel IN 46032 1083 Churchman Ave. Wk Ph: (317)
Beech Grove IN 46107 Cell Ph: (317)784-3598
karelann @att.net
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Facility Reservation Details
CANCELLATION Refund Of 107.00
Facility: West Park, West Park Shelter
Reserv. Contact: Karel Seldner, Cell: (317)784 -3598
Reserv. Number: 12618 Status: Cancelled
Purpose: Birthday Party Seldner
Anticipated Count: 37
Date Day Time Fees Tax Discount Prev Paid Cur Paid Amount Due
05/16/2010 Sun 1:OOP to 6:00P 0.00 0.00 0.00 0.00 0.00
Cancel Reason: conflict with other event
GIL Code Description Account Number Cst Cntr Descri Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 107.00 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 05/10/10 12:11:36 by MCC FEES CHANGED ON CANCELLED ITEMS 100.00
SALES TAX CHARGED ON CANCELLED FEES 7.00
kNET 4MOUNT FWMZANCELLED ITEMS*X 7 a .'10T00 -y"
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 107.00 Made By REFUND FINAN With Reference event conflict
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.
The count for this line item will not be known until after the reservation date. Therefore, both the count and the extension are
left at zero for reservation purposes, but will be updated after the reservation date. As soon as this data is available, you will
be invoiced for the current amo t due. Please remit to our office within 10 days of the invoice date.
Authorized 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.
Seidner, Karel Terms
1083 Churchman Ave Date Due
Beech Grove, IN 46107
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5110110 418965 Refund 107.00
Total 107.00
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,
Seidner, Karel Allowed 20
1083 Churchman Ave
Beech Grove, IN 46107
In Sum of
107.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1095 -3 418965 4358400 107.00 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
20 -May 2010
Signature
107.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund