186912 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 364260 Page 1 of 1
`i. ONE CIVIC SQUARE PATRICIA KWAN
0 CHECK AMOUNT: $69.00
CARMEL, INDIANA 46032 11866 ESN WAY
CARMEL IN 46033 CHECK NUMBER: 186912
CHECK DATE: 6/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 435428 69.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 435428
Payment Date: 06/08/10
Household 26472
Monon Community Center Patricia Kwan Hm Ph: (317)564 -4308
Carmel IN 46032 11866 Esty Way Wk Ph: (317)488 -6884
Carmel IN 46033 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 69.00
Pass Holder: Georgina Kwan Chia Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: KZ 50 Visit (M Z50), #68025 6.00 0.00 6.00 0.00 0 -00
Valid Dates: 05/20/2009 to 12/31/2099 Pass Cancellation)
Pass Visit Info: Number of Visits: 46
Cancel Reason: pro -rated request
G/L Code Description______ Account -Number Cst -Cntr Description- Account Number _Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 69.00 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 06/08/10 05:13:32 by LVA FEES CHANGED ON CANCELLED ITEMS 69.00
NET AMOUNT FROM CANCELLED ITEMS 69.00
TOTAL AMOUNT REFUNDED 69.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 69.00 Made By REFUND FINAN With Reference pro -rated request
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issue o cash or credit card refunds.
/00
Authorized Si q ature Date Authori ed Signature Date
WOO
JUN f, fJ 2010
Pr Deq, ue* Y o
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.
Kwan, Patricia Terms
11866 Esty Way Date Due
Carmel, I N 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/8/10 435428 Refund 69.00
Total 69.00
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
1 20
Clerk- Treasurer
Voucher No, Warrant No.
Kwan, Patricia Allowed 20
11866 Esty Way
Carmel, IN 46033
In Sum of
69.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or Board Members
Dept ept INVOICE NO. ACCT #/TITLE AMOUNT
1096 -41 435428 4358400 69.00 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
69.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund