186795 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 364256 Page 1 of 1
a ONE CIVIC SQUARE CHRISTINE DORON CHECK AMOUNT: $91.00
CARMEL, INDIANA 46032 1277 HELFORD LANE
CARMEL IN 46032 CHECK NUMBER: 186795
CHECK DATE: 6/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358400 434563 91.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 434563
Payment Date: 06/07/10
Household 27769
Monon Community Center Christine Doron Hm Ph: (317)339 -6808
Carmel IN 46032 1277 Helford Lane Wk Ph: (317)594 -9259
Carmel IN 46032 Cell Ph:
cjdoron @traffiesignalcompany.com
Phone: (317)848 -72.75
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 91.00
Pass Holder: William Doron Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 10 -Visit (ESE10V), #82667 39.00 0.00 39.00 0.00 0.00
Valid Dates. 08/11/2009 to 05/27/2010 Pass Cancellation)
Pass Visit Info: Number of Visits,-
cancel Reason: grader -will no longer attend
G/L Code Descr_ n uiit Number Cst Cntr Descriptio Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 91.00 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 06/07/10 10:51:37 by JAB FEES CHANGED ON CANCELLED ITEMS 91.00
NET AMOUNT FROM CANCELLED ITEMS TOTAL AMOUNT AMOUNT REFUNDED 91.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 91.00 Made By REFUND FINAN With Reference check refund
efunds ar ubject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issu J. No c sh or credit card refunds.
Au o ed V9 nature Date Authorized Signature Dale
JUN o 12010
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.
Doron, Christine Terms
1 277 Helford Lane Date Due
Carmel; IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6!7110 434563 Refund 91.00
Total 91.00
l 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
,2o
Clerk- Treasurer
Voucher No. Warrant No.
Doron, Christine Allowed 20
1277 Helford Lane
Carmel, IN 46032
In Sum of$
91.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1081 -10 434563 4358400 91.00 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
17 -Jun 2010
Signature
i 91.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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