186949 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 364261 Page 1 of 1
ONE CIVIC SQUARE VIRGINIA MOSBAUGH
c CARMEL, INDIANA 46032 1227 KINGS COVE CT CHECK AMOUNT: $170.00
INDIANAPOLIS IN 46260
CHECK NUMBER: 186949
CHECK DATE: 6/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1092 4358400 432904 170.00 REFUNDS AWARDS INDE
t
PASS REFUND RECEIPT
T
Receipt 432904 `r
Payment Date: 06/04/2010
Household 35269 J 0 7
Home Phone: (317)818 -8911
Work Phone: (317)
Y o
VIRGINIA MOSBAUGH Monon Community Center
1227 KINGS COVE CT Carmel IN 46032
INDIANAPOLIS IN 46260
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 85.00
Pass Holder: Virginia Mosbaugh Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Seas AQ Adult (SAQAR), #108110 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/29/2010 to 09/06/2010 Pass Cancellation)
Cancel Reason: Pool too crowded,no adult areas, not what we expected.
CANCELLATION Refund Of 85.00
Pass Holder: Lars Horne Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Seas AQ Adult (SAQAR), #108109 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/29/2010 to 09/06/2010 Pass Cancellation)
Cancel Reason: Pool too crowded,no adult areas, not what we expected.
G/L Code Description Account Number Cst Cntr Descripti Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 170.00 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 06/04 /10 12:02:09 by CRB FEES CHANGED ON CANCELLED ITEMS 170.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
FIN ETr%MOUNTgFROWCANGELLED )ITEMS r 170100
TOTAL�;'AM00NTiREFUNDEDE C t r ,170[00:
Y` IrQ NEW NET HOUSEHOLD BALANCE 0.00
Refund of 170.00 Made By REFUND FINAN With Reference
Page 1
5
PASS REFUND RECEIPT
Receipt 432904
Payment Date: 06/04/2010
Household 35269
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.
Authorized Signature Date Authorized Signature Date
JUG
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.
Mosbaugh, Virginia Terms
1227 Kings Cove Ct Date Due
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
614110 432904 Refund 170.00
Total 170.00
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.
Mosbaugh, Virginia Allowed 20
1227 Kings Cove Ct
Indianapolis, IN 46260
In Sum of$
170.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1(0 9A 432904 4358400 170.00 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
170.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund