162275 08/07/2008 CITY OF CARMEL, INDIANA VENDOR; T0003029 Page 1 of 1
ONE CIVIC SQUARE KIMBERLY BREMER
I' CHECK AMOUNT: $168.00
CARMEL, INDIANA 46032 5308 BREAKERS WAY
CARMEL IN 46033 CHECK NUMBER: 162275
o
CHECK DATE: 81712008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NU MBER AMOUNT DESCRIPTION
„1047 4358400 168.00 PARKS DEPARTMENT REFU
L
ACTIVITY REFUND RECEIPT
Receipt 159609 fir.
Payment Date: 07/23/2008 P 1, P, V D
Household 533
Hone Phone: (317)571 -0405 JUL 2 5 2008
Work Phone:
KIMBERLY BREMER Monon Center
5308 BREAKERS WAY Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 84.00
Enrollee Name: Nicholas Bremer Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 185316 -02 Pee Wee Golf Camp 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 05/06/2008 (Cancelled)
Primary Instructor: Plum Creek Golf
Class Location. Plum Creek Golf Club Class Dates: 07/1512008 to 07118/2008
Plum Creek Golf Cour 8:30A to 9:30A
12401 Lynnwood Blvd. Tu,W,Th,F
Carmel, IN 46033
(317)848 -7275 Scheduled Sessions: 4
Cancel Reason: on waitlist and never got in
CANCELLATION Refund Of 84.00
Enrollee Name: Grant Bremer Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 185316 -02 Pee Wee Golf Camp 0.00 0.00 0.00 0.00 OM
Enrollment Date: 05/06/2008 (Cancelled)
Primary Instructor: Plum Creek Golf
Class Location: Plum Creek Golf Club Class Dates. 07/15/2008 to 0 711 8/2 00 8
Plum Creek Golf Cour 8:30A to 9:30A
12401 Lynnwood Blvd. Tu,W,Th,F
Carmel, IN 46033
(317)848 -7275 Scheduled Sessions: 4
Cancel Reason: on waitlist and never got in
G/L Code Description Ac count !Number Cst Cntr Description Account Numb Am ount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 168.00 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.
Page 1
ACTIVITY REFUND RECEIPT
Receipt 159609
Payment Date: 07/23/08
Household 533
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 07/23/08 09:06:35 by CNA FEES CHANGED ON CANCELLED ITEMS 168.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED: ITEMS 168.00
TOTAL AMOUNT REFUNDED 168.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 168.00 Made By REFUND FINAN With Reference on waitlist; never got in
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.
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A uthorized Signature Date Authorized Signature Date
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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.
Bremer, Kimberly Terms
5308 Breakers Way Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/23/08 159609 Refund 168.00
Total 168.00
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.
Bremer, Kimberly Allowed 20
5308 Breakers Way
Carmel, IN 46033
In Sum of
168.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1047 159609 4358400 168.00 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
25 -Jul 2008
�4�chzm�
Signature
168.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund