163168 09/03/2008 CITY OF CARMEL, INDIANA VENDOR: T361791 Page 1 of 1
ONE CIVIC SQUARE JARRED BURNTEIN
CARMEL, INDIANA 46032 4621 ALDERSGATE CHECK AMOUNT: $522.81
CARMEL IN 46032
CHECK NUMBER: 163168
CHECK DATE: 9/3/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400. 139366 522.81 REFUNDS AWARDS INDE
S
GLOBAL REFUND RECEIPT
Receipt 180857
Payment Date: 08/25/2008 =BY:
Household 13845
Home Phone: (317)317 -0171
Work Phone:
JARRED BURNSTEIN Monon Center
A' 4621 ALDERSGATE Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Oriq Bal RefVn New Bal
Module: Pass Management 522.81- 522.81 0.00
G1L Code Descri Ac count Number C st Cnlr Descri Account N Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 522.81 DR
Finance will have to DEBIT the CONTROL account for the amounts listed above after the checks have been written to the customers.
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 522 -81
Processed on 08/25/08 10:05:27 by EDR NEW REFUND AMOUNT 522 -81
TOTAL REFUNDABLE AMOUNT 522.81'
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 522.81 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.
Zc4 U�
Authorized Si nature Date Authorized Sign lure Date
4�t 3co
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.
Burnstein, Jarred Terms
r
4621 Aldersgate Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8125108 180857 Refund 522.89
Total 522.81
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.
Burnstein, Jarred Allowed 20
4621 Aldersgate
Carmel, IN 46032
In Sum of
i,
522.81
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE No. ACCT #ITITL AMOUNT Board Members
Dept
1047 180857 4358400 522.81 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
28 -Aug 2008
Signature
522.81 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund