187050 06/23/2010 a CITY OF CARMEL, INDIANA VENDOR: 364267 Page 1 of 1
ONE CIVIC SQUARE PAUL TAN
CARMEL, INDIANA 46032 1230 TURNER DRIVE CHECK AMOUNT: $54.00
INDIANAPOLIS IN 46280
CHECK NUMBER: 187050
CHECK DATE: 6/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 431451 54.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 431451
Payment Date: 06/02/10
Household 20934
Monon Center Paul Tan Him Ph: (317)271 -0884
Carmel IN 46032 1230 Turner Drive
Indianapolis IN 46280 Cell Ph:
wetan_srnsd @yahoo.com
Phone: (317)848 -7275
Fed'Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 54.00
Pass Holder. Paul Tan Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: KZ 50 Visit (M Z50), #45387 21.00 0.00 21.00 0.00 0.00
Valid Dates: 11/08/2008 to 12/31/2099 Pass Cancellation)
Pass visit Into. Number of Visits: 36
Cancel Reason: pro -rated request
GA_ 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 54.00 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 06/02/10 09:43:01 by LVA FEES CHANGED ON CANCELLED ITEMS 54.00
NET AMOUNT FROM CANCELLED ITEMS 54.00
TOTAL AMOUNT REFUNDED 54.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 54.00 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
issued cash or credit and refunds.
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Authorized Signatu Date Authori d Signature Date
`SUN 1.10 1
C-eques k-
Page 1
e 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.
Tan, Paul Terms
1230 Turner Drive Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
612110 431451 Refund 54.00
Total 54.00
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.
Tan, Paul Allowed 20
1230 Turner Drive
Indianapolis, IN 46280
in Sum of$
54.00
ON ACCOUNT OF APPROPRIATION FOR
109. Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096 -41 431451 4358400 54.00 1 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
54.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund