166699 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: T362231 Page 1 of 1
ONE CIVIC SQUARE RICHARD HANSEN CHECK AMOUNT: $15.00
!a CARMEL, INDIANA 46032 11006 WINTERCOVE WAY
FISHERS IN 46038 CHECK NUMBER: 166699
CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBER INV OICE NUMBE AMOUNT DESCRIPTION
1047 4358400 202892 15.00 REFUNDS AWARDS INDE
p
T
ACTIVITY REFUND RECEIPT
Receipt 202892
Payment Date: 11/17/2008
Household 21367
Home Phone: (317)288 4333 D EC 0 1 2008
Work Phone: (317)295 -5240
RICHARD HANSEN Monon Center
11006 WINTERCOVE WAY Carmel IN 46032
FISHERS IN 46038
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 15.00
Enrollee Name: Mona Hansen Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 284200 -07 Zumba 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 09/02/2008 (Cancelled)
Primary Instructor: Zumba
Class Location: Fitness Studio B Class Dates: 12/02/2008 to 12/16/2008
Monon Center 6:OOP to 6:50P
Tu
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 3
Fee Details: Fee Desc rtion Amount Count Discount Sales Tax Total Fee
Zumba 7.00 1.00 0.00 0.00 7.00
Cancel Reason: Not satisfied with class.
G/L Code Descrip Account Num ber Cst Cntr Descri _Ac count Nu mber Am ount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 15.00 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 11/17/08 12:09:44 by CEK FEES CHANGED ON CANCELLED ITEMS 22.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 7.00
NET AMOUNT FROM CANCELLED ITEMS 45.00
TOTAL AMOUNT REFUNDED 15.00
NEW NET HOUSEHOLD BALANCE 0.00
Page 1
ACTIVITY REFUND RECEIPT
Receipt 202892
Payment Date: 11/17/2008
Household 21367
Refund of 15.00 Made By REFUND FINAN With Reference class cancellation
Rewards Points refunded on this receipt: 0.70
Household Reward Point Balance: 11,20
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.
1 111 1 01% 6 l
Authorized Signature Date Authorized Signature Date
;S
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.
Hansen, Richard Terms
11006 Wintercove Way Date Due
Fishers, IN 46038
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/17/08 202892 Refund 15.00
Total 15.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Hansen, Richard Allowed 20
11006 Wintercove Way
Fishers, IN 46038
In Sum of
15.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 202892 4358400 15.00 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
5 -Dec 2008
Signature
15.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund