186274 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 364228 Page 1 of 1
ONE CIVIC SQUARE CHUNJIN DING
CARMEL, INDIANA 46032 5405 LOCHMERE DR CHECK AMOUNT: $355.00
CARMEL IN 46033
CHECK NUMBER: 186274
CHECK DATE: 6/9/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 355.00 REUNF
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PASS REFUND RECEIPT
Receipt 426195
Payment Date: 05/25/10
Household 2302
MAY 2 5 2010
Monon Center Chunjin Ding Hm Ph: (317)848 -1738
Carmel IN 46032 5405 Lochmere Dr. Wk Ph: (317)276 -1237
BY: Carmel IN 46033 Cell Ph: (317)
F '/one: (317)848 -7275 chunjinding2001 @yahoo.com
Fed Tax ID #35- 6000972
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Pass Details
CANCELLATION Refund Of 195.00
Pass Holder: Katherine Long Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 20 -Visit (ESE20V), #87533 25.00 0.00 25.00 0.00 0.00
Valid Dates: 08/11/2009 to 05/27/2010 Pass Cancellation)
Pass Visit Info: Number of Visits: 18
Cancel Reason: prorated refund; 5th grader
CANCELLATION Refund Of 130.00
Pass Holder: Katherine Long Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 10 -Visit (ESE10V), #87534 0.00 0.00 0.00 0.00 0.00
Valid Dates: 08/11/2009 to 05/27/2010 Pass Cancellation)
Pass Visit Info: Number of Visits: 10
Cancel Reason: prorated refund; 5th grader
The following item reflects a payment towards a previous receipt
Pass Holder: Katherine Long Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Drop -In Visit (ESEDROP), #87537 14.00 0.00 12.00 2.00 0.00
Valid Dates: 08/11/2009 to 05/27/2010 Pass Change)
The following item reflects a payment towards a previous receipt
Pass Holder: Katherine Long Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Drop -In Visit (ESEDROP), #87538 14.00 0.00 0.00 14.00 0.00
Valid Dates:. 08/11/2009 to 05/27/2010 Pass Change)
The following item reflects a payment towards a previous receipt
Pass Holder: Katherine Long Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Drop -Fn Visit (ESEDROP), #87539 14.00 0.00 0.00 14.00 0.00
Valid Dates: 08/11/2009 to 05/27/2010 Pass Change)
G1L Code Descri Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 355.00 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.
Page 1
PASS REFUND RECEIPT
Receipt 426195
Payment Date: 05/25/2010
Household 2302
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 30.00
Processed on 05/25/10 09:34:29 by JAB FEES CHANGED ON CANCELLED ITEMS 355.00
NET AMOUNT.FROM CANCELLED ITEMS 355.00
FEES ADJUSTED ON CHANGED ITEMS 0.00
NET AMOUNT FROM CHANGED ITEMS
TOTAL AMOUNT REFUNDED 355.00
NEW NET CREDIT HOUSEHOLD BALANCE 30.00
Refund of 355.00 Made By REFUND FINAN With Reference check refund
Payment of 30.00 Made By Pass Management Credit Balance
efunds ar subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issu No c sh or credit rd refunds.
Au orized Signature Date Authorized Signature Date
Page #2
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.
Ding, Chunjin Terms
5405 Lochmere Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5125110 426195 Refund 355.00
Total 355.00
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.
Ding, Chunjin Allowed 20
5405 Lochmere Dr
Carmel, IN 46033
In Sum of
355.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members
Dept
1081 -7 426195 4358400 355.00 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
3 -Jun 2010
T
Signature
355.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund