186824 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 364257 Page 1 of 1
ONE CIVIC SQUARE STEPHANIE GOMMERY CHECK AMOUNT: $160.00
CARMEL, INDIANA 46032 8120 ROSEMEAD LANE
INDIANAPOLIS IN 46240 CHECK NUMBER: 186824
CHECK DATE: 6/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 439822 160.00 REFUNDS AWARDS INDE
ti
t
ACTIVITY REFUND RECEIPT
Receipt 439822
Payment Date: 06/14/10
Household 34517
Monon Community Center Stephanie Gommery Hm Ph: (317)536 -4110
Carmel IN 46032 8120 Rosemead Lane
Indianapolis IN 46240 Cell Ph: (317)544-9908
Phone: (317)848 -7275 steffi.gommery@gmail.com
F;Od Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 160.00
Enrollee Name: Kim Gommery Fees Tax Discount Prey Paid Cur Paid Amount Due
Activity Number: 476001 -03 Vacation Station 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 04/23/2010 (Cancelled)
Class Location: Creekside Middle Sch Class Dates: 06/14/2010 to 06/18/2010
Creekside Middle Sch 7:OOA to 6:OOP
3525 W. 126th Street M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848 -7275
Cancel Reason: supplied w/ incorrect camp information (resulting in camp cancellation correct info does not
work for her)
G/L Code Descri Acc ount Number Cst Cntr_ Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 160.00 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 06/14/10 10:45:14 by BJJ FEES CHANGED ON CANCELLED ITEMS 160.00-
1 NET AMOUNT FROM CANCELLED'ITEMS 160.00
TOTAL AMOUNT REFUNDED 160.D0
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 160.00 Made By REFUND FINAN With Reference
All refunds are subject to State Board o f Accounts claim procedure and may take 4 -6 weeks to process A check w II be
issued. o cash or credit card refunds.
Z7,!Leld
Signature Date Authorized Signature Date
rl Page 1
r
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.
Gommery, Stephanie Terms
r 8120 Rosemead Lane Date Due
1 7 Indianapolis, IN 46240
Invoice Invoice Description
D ate Number (or note attached invoices) or bill(s)) Amount
64110 439822 Refund 160.00
Total 160.00
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.
Gommery, Stephanie Allowed 20
8120 Rosemead Lane
Indianapolis, IN 46240
In Sum of
160.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -1 439822 4358400 160.00 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
160.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund