165193 10/29/2008 CITY OF CARMEL, INDIANA VENDOR: T362041 Page 1 of 1
g 0 ONE CIVIC SQUARE KIMBERLY DAVIS CHECK AMOUNT: $98.00
CARMEL, INDIANA 46032 10750 BELLFOUNTAIN ST
INDIANAPOLIS IN 46280 CHECK NUMBER: 165193
CHECK DATE: 10/29/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 194279 98.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 194279 RRC_ 'TVF_
Payment Date: 10/14/2008
Household 17625
Home Phone: (317)846 -4159 'IT 2 2 2008
Work Phone: (317)
BY:
KIMBERLY DAVIS Monon Center
10750 BELLFOLINTAIN ST. Carmel IN 46032
INDIANAPOLIS IN 46280
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 34.00
Enrollee Name: Kimberly Davis Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 287112 -01 Hip Hop 15.00 0.00 0.00 15.00 0.00
Enrollment Date: 09/22/2008 (Cancelled)
Primary Instructor: Dance Class Studio
Class Location: Dance Studio Class Dates: 09/27/2008 to 11/15/2008
Monon Center 8:OOA to 8:45A
Sa
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 8
Fee Details: Fee Description Amount Count Disc ount Sales Tax Total Fee
Adult Hip Hop Reside 15.00 1.00 0.00 0.00 15.00
Cancel Reason: unsatisfied
CANCELLATION Refund Of 64.00
Enrollee Name: Elizabeth Hormuth Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 287112 -01 Hip Hop 15.00 0.00 0.00 15.00 0.00
Enrollment Date: 09/22/2008 (Cancelled)
Primary Instructor: Dance Class Studio
Class Location: Dance Studio Class Dates: 09/27/2008 to 11/15/2008
Monon Center 8:OOA to 8:45A
Sa
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 8
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Adult Hip Hop Reside 15.00 1.00 0.00 0.00 15.00
Cancel Reason: unsatisfied
Page 1
ACTIVITY REFUND RECEIPT
Receipt 194279
Payment Date: 10/14/2008
Household 17625
G/ Code Descri Account Number Cst Cntr Descripti Acco Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 98.00 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 10/14/08 14:08:36 by MML FEES CHANGED ON CANCELLED ITEMS 128.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 30.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 98.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 98.00 Made By REFUND FINAN With Reference unsatisfied
Rewards Points refunded on this receipt: 3.00
Household Reward Point Balance: 15.80
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issue a h or redit c rd ref hds.
Authorized Signature Date l Authorized Signature Date
47 570, 506 q3 S N0
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.
Davis, Kimberly Terms
10750 Bellfountain St Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/14/08 194279 Refund 98.00
Total 98.00
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.
Davis, Kimberly Allowed 20
10750 Bellfountain St
Indianapolis, IN 46280
In Sum of
98.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept
1047 194279 4358400 98.00 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
98.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund