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Home My WebLink About165161 10/29/2008 CITY OF CARMEL, INDIANA VENDOR: T362038 Page 1 of 1 ONE CIVIC SQUARE CASEY CAMMACK CHECK AMOUNT: $57.00 CARMEL, INDIANA 46032 13268 BLACKTERN WAY CARMEL IN 46033 CHECK NUMBER: 165161 CHECK DATE: 10/29/2008 DEPARTMENT ACCOUNT PO NUMBER INVOI NUMBER AMOUNT DESCRIPTION -1047 4358400 195585 57.00 REFUNDS AWARDS INDE PASS REFUND RECEIPT 7 7 Receipt 195585 Payment Date: 10/16/2008 Household 16389 Home Phone: (317)846 -8229 Work Phone: (317)433 -0361 CASEY CAMMACK Monon Center 13268 BLACKTERN WAY Carmel IN 46032 CARMEL IN 46033 Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Pass Details CANCELLATION Refund Of 32.00 Pass Holder: Casey Cammack Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Prem. Yriy Ad R (PRMYRADR), #21615 224.00 0.00 0.00 224.00 0.00 Valid Dates: 03/01/2008 to 03/01/2009 Pass Cancellation) Fee Details: Fee Des Amount Count Discount Sales Tax Total Fee Prem. Yearly Adult R 224.00 1.00 0.00 0.00 224.00 Cancel Reason: Never used and no longer wants pass CANCELLATION Refund Of 25.00 Pass Holder: Cammack Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Vu AQ Yth Res 10 (VAQYR10), #42683 0.00 0.00 0.00 0.00 0.00 Valid Dates: 10/15/2008 to 12/31/2099 Pass Cancellation) Pass Visit Info: Number of Visits: 9 Cancel Reason: Never used and no longer wants pass G/L Code Description Account Number Cst Cntr Description Account Number Am ount 999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 57.00 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 10116/08 10:44:04 by EMB FEES CHANGED ON CANCELLED ITEMS 281.00 DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00 SALES TAX CHARGED ON CANCELLED FEES 0.00 SURCHARGE APPLIED AGAINST CANCELLED FEES O 224.00 NET :AMOUNT °FROM CANCELLED ITEMS_ 57:00'',;1 hTOTAL�:'AMOUNT:REFUNDEDI,^ 57:00.11 H -7 NEW NET HOUSEHOLD BALANCE 0.00 Page 1 PASS REFUND RECEIPT A Receipt 195585 Payment Date: 10/16/2008 Household 16389 1 Refund of 57.00 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. &nkw 10 r� Authorized Sig ture Date Authorized Signature Date Page 2 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL f 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. i Payee Purchase Order No. Cammack, Casey Terms 13268 Blacktern Way Date Due Carmel, IN 46033 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 10/16/08 195585 Refund 57.00 Total 57.00 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. Cammack, Casey Allowed 20 13268 Blacktern Way Carmel, IN 46033 In Sum of 57.00 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept 1047 195585 4358400 57.00 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 22 -Oct 2008 Signature 1 57.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund