187328 07/07/2010 CITY OF CARMEL, INDIANA VENDOR: 363852 Page 1 of 1
d ONE CIVIC SQUARE ROLAND HOFER
CARMEL, INDIANA 46032 13652 FOSSIL DRIVE CHECK AMOUNT: $99.00
WESTFIELDIN 46074
CHECK NUMBER: 187328
CHECK DATE: 71712010
DEPARTMENT A CCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 449492 99.00 REFUNDS AWARDS TNDE
ACTIVITY REFUND RECEIPT
Receipt 449492
Payment Date: 06/21/10
d
T9VTRW%1 Household 6490
JUN2Z2010
Nionon Community Center Roland Hofer Hm Ph: (317)732 -4131
Carmel IN 46032 13652 Fossil Drive
BY: Westfield IN 46074 Cell Ph:
1v rojo_46032@yahoo.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 99.00
Enrollee Name: Justin Hofer Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476009 -11 Skyhawks Spouts 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 06102/2010 (Cancelled)
Class Location: Skate Park Class Dates: 06/21/2010 to 06/25/2010
Monon Community Cntr 11:30A to 1:30P
M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions: 5
(317)848 -7275
Cancel Reason: unable to attend due to injury
G1L Code_ Description Account Number C C ntr_ Descri ption Ac count Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 99.00 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 06/21/10 11:11:49 by BJJ FEES CHANGED ON CANCELLED ITEMS 99.00
NET AMOUNT `FROM +CANCELI ED ITEMS 99'9011 a
TOTAL .AMOUNT 'REFUNDED 99:00'
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 99.00 Made By REFUND FINAN With Reference
All refunds e subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. N or credit card r
Auth ignature Date Authorized Signature Date
Page 9 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.
Hofer, Roland Terms
i 13652 Fossil Drive Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)} Amount
6!21110 449492 Refund 99.00
Total 99.00
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.
Hofer, Roland Allowed 20
13652 Fossil Drive
Westfield, IN 46074
In Sum of
99.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members
Dept
9082 -98 449492 4358400 99.00 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
99.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund