187260 07/07/2010 CITY OF CARMEL, INDIANA VENDOR: 361223 Page 1 of 1
f ONE CIVIC SQUARE HOLLY CLOUSE
11221 WHITE WATERWAY
CHECK AMOUNT: $118.00
CARMEL, INDIANA 46032
FISHERS IN 46038 CHECK NUMBER: 187260
CHECK DATE: 7/7/2010
DEPAR ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION
1096 4358400 449502 118.00 REFUNDS AWARDS INDE
f�\. r rtiu a II RA: A'IAA�ttJ tR�VtCAA" A
Receipt 449502
Payment Date: 06/21/10
Household 28541
Monon Community Center JUN 2 3 2010 Holly Clouse Hm Ph: (317)625 -2131
Carmel IN 46032 11221 Whilewater Way
Fishers IN 4W38 Cell Ph:
douse627@oomeast.net
Phone: (317)848 -7275 BY:
Fed Tax iD #35- 6000972
Enrollment Details
CANCELLATION Refund Of 118.00
Enrollee Name: Harrison Clouse Fees Tax Dkxxwrvt Prey Paid Cur Paid Amount Out
Activity Number 105006 -06 Lil' Kicker Hopper 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 0611512010 (Cancelled)
Primary Instructor. Off the Wall Sports
Glass Location: Inlow Park Field 3 Class Dates: 06/05/2010 to 08/14/2010
INow Park 9:30A to 10:20A
6310 E. 131 st Street Sa
Carmel, IN 46032 Scheduled sessions: 10
(317)848 -7275
Skip Days 07/03/2010
Cancel Reason: prorated request
GIL Code Description Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Contra! A=mt (AP) Enter Control Acct here 118.00 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 anmtrnts fisted above after the dads have been written to the customers,
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 06/21/10 1127:21 by CNA FEES CHA14GED ON CANCELLED ITEMS 125.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 7.00
NET AMOUNT FROM CANCELLED ITEMS 118.00•
TOTAL AMOUNT REFUNDED 118.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 118.00 Made By REFUND FINAN With Reference prorated 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. No cash or credit card refunds.
IV," li o 6 aD-� a� �o
Au orized Signature Date Aul&ized Signature Date
1 090.38. y 35 y y0 g �uesf
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.
Clouse, Holly Terms
11221 Whitewater Way Date Due
,t Fishers, IN 46038
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6121110 449502 Refund 118.00
Total 118.00
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.
Clouse, Holly Allowed 20
11221 Whitewater Way
Fishers, IN 46038
In Sum of
118.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1096 -32 449502 4358400 118.00 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
1 -Jul 2010
Signature
I 118.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund