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Home My WebLink About166122 11/24/2008 CITY OF CARMEL, INDIANA VENDOR: T362175 Page 1 of I z ONE CIVIC SQUARE RAYMOND BARCLAY CHECK AMOUNT: $30.00 CARMEL, INDIANA 46032 3548 NORTH RAMSGATE ROAD MARTINSVILLE IN 46151 CHECK NUMBER: 166122 CHECK DATE: 11/24/2008 DE PARTMENT A CC O UNT P O NUMBE INVOICE NU A MOUNT DESCRIPTION (1.047 4358400 198851 30.00 REFUNDS AWARDS INDE t PASS REFUND RECEIPT C F1 FVF D Receipt 198851 Payment Date: 11103/2008 Houlsehold 13075 �O� 12 2008 Howie Phone: (765)349 -5644 Work Phone: (317)571 -3761 BY: RAYMOND A BARCLAY Monon Center 3548 NORTH RAMSGATE ROAD Carmel IN 46032 MARTINSVILLE IN 46151 Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Pass Details CANCELLATION Refund Of 30.00 Pass Holder: Raymond A Barclay Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Yly FT Alt Non (YFTAN), #20273 240.00 0.00 0.00 240.00 0.00 Valid Dates: 0113112008 to 01/31/2009 Pass Cancellation) Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee Yearly Fitness Adult 240.00 1.00 0.00 0.00 240.00 Cancel Reason: Has corporate pass now. G1L Code Description Ac count Number Cst Cntr Description Account Number Amount 999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 30.00 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 11/03/08 12:28:47 by EMB FEES CHANGED ON CANCELLED ITEMS 270.00 DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00 SALES TAX CHARGED ON CANCELLED FEES 0.00 SURCHARGE APPLIED AGAINST CANCELLED FEES O 240.00- NET. AMOUNT FROM'CANCEL'L''EDITEMS 30x00 TOTAL'AMOUNTi REFUNDED ,M NEW NET HOUSEHOLD BALANCE 0.00 Refund of 30.00 Made By REFUND FINAN With Reference 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. 1� 1W 91&tw 1 :22 Authorized dignattre Date Authorized Signature Date 1 7 �4D N LiSS —Z q'' O Page #1 PASS REFUND RECEIPT Receipt 198851 Payment Date: 11/03/2008 Household 13075 Page 2 -r 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. Barclay, Raymond A Terms 3548 North Ramsgate Road Date Due Martinsville, IN 46151 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 1113108 198851 Refund 30.00 Total 30.00 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. Barclay, Raymond A Allowed 20 3548 North Ramsgate Road Martinsville, IN 46151 In Sum of l� 30.00 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT#/ AMOUNT Board Members Dept 1047 198851 4358400 30.00 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 -Nov 2008 Signature 30.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund