165801 11/12/2008 CITY OF CARMEL, INDIANA VENDOR: 00352604 Page 1 of 1
ONE CIVIC SQUARE DAVID HOESMAN CHECK AMOUNT: $96.00
i; as CARMEL, INDIANA 46032 CIO CARMEL UTILITIES
or CIO CARMEL UTILITIES CHECK NUMBER: 165801
o= CHECK DATE: 1 111 212 0 08
DEP ARTMENT ACCOUNT PO NUMBER INVOICE NU MBER AMOUNT DESCRIPTION
1047 4358400 96.00 PARIS DEPARTMENT REFU
i
PASS REFUND RECEIPT
Receipt 179449
Payment Date: /5856 08121/2008 7icOCT rP1TVFD
Household 15856
Home Phone: (317)706 -9656
Work Phone: (317)247 -0005 2 7 2008
DAVID HOESMAN Monon Center
10284 ORCHARD PARK DR S Carmel IN 46032
INDIANAPOLIS IN 46280
Phone: (317)848 -7275
Fed Tax I D #35- 6000972
Pass Details
Pass Holder. Ryan Moore Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #36336 20.00 0.00 0.00 20.00 0.00
Valid Dates. 08/21/2008 to 08/21/2009 Pass Transfer from Prem. Yrly Ad R)
Auto -Debit Details. 11 Future Bill(s) Totaling $220.00
Fee Details Fee Descri Amount Count Discount Sales Tax Total Fee
Yearly Fitness Adult 20.00 1.00 0.00 0.00 20.00
G/L Code Descri Ac count Nu mber Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 76.00 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 08/21/08 19:45:02 by ARH FEES ADJUSTED ON CHANGED ITEMS 76.00
DISCOUNT APPLIED AGAINST THESE FEES O 0.00
NET FROM/TO TRANSFER TAX 0.00
NET AMOUNT'FROM CHANGED ITEMS 76.00
TOTAL AMOUNT REFUNDED 76.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 76.00 Made By REFUND FINAN With Reference
Payment of 20.00 Made By Pass Management Credit Balance
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. loy
Authorized Signature Date ''Authorized Signature Date
Page 1
PASS REFUND RECEIPT
Receipt 196406
Payment Date: 1012112008
Household 15856
Home Phone: (317)706 -9658
Work Phone: (317)247 -0005 O C T
2 7 2008
BY:
DAVID HOESMAN Monon Center
10284 ORCHARD PARK DR S Carmel IN 46032
INDIANAPOLIS IN 46280
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 20.00
Pass Holder. Ryan Moore Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type. Yly FT Alt Res (YFTAR), #36336 20.00 0.00 20.00 0.00 0.00
Valid Dates: 08/21/2008 to 08/21/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sale Tax Total F ee
Yearly Fitness Adult 20.00 1.00 0.00 0.00 20.00
Cancel Reason: Does not want this pass.
GIL Code Descri Account Number Cst Cntr Descriptio Account Numbe Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 20.00 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 10/21/08 15:41:17 by EMB FEES CHANGED ON CANCELLED ITEMS 20.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS 20.00
TOTAL AMOUNT REFUNDED 2D.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 20.00 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.
1
[c) t 1 F i f Z/ v
Authorized SiJnature Date Authorize i na e Date
Page 9 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.
Hoesman, David Terms
10284 Orchard Park Dr S Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/21108 179449 Refund 76.00
10/21/08 196406 Refund 20.00
Total 96.00
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.
Hoesman, David Allowed 20
10284 Orchard Park Dr S
Indianapolis, IN 46280
In Sum of
96.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1047 179449 4358400 76.00 1 hereby certify that the attached invoice(s), or
1047 196406 4358400 20.00 bili(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
31 -Oct 2008
Signature
96.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund