160906 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 361459 Page 1 of 1
ONE CIVIC SQUARE NATALIE HOLSTEIN CHECK AMOUNT: $1,040.00
CARMEL, INDIANA 46032 11748 SHAWDOWWOOD COURT
ZIONSVILLE IN 46077 CHECK NUMBER: 160906
CHECK DATE: 6/25/2008
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
F
1047 4358400 1,040.00 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 120778
Payment Date: 05/30/2008
Hjusehold 7972
Home Phone: (317)873 -8610
Work Phone: (317)
NATALIE HOLSTEIN Carmel Clay Parks Recreation
11748 SHADOWWOOD COURT 1235 Central Park Drive East
ZIONSVILLE IN 46077 Carmel IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 1,040.00
Pass Holder: Natalie Holstein Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prem. Yrly HH R (PRMYRHHR), #26031 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/30/2008 to 05/30/2009 Pass Cancellation)
Cancel Reason: Doesn't use enough, and realized that didn't have to be member to take classes
CANCELLATION
Pass Holder: Shawn Holstein Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prm Yr HH Add R (PRMHHADR), #26032 0.00 0.00 0.00 0.00 0.00
Valid bates: 05/30/2008 to 05/30/2009 Pass Cancellation)
Cancel Reason: Doesn't use enough, and realized that didn't have to be member to take classes
CANCELLATION
Pass Holder: Mikayla Holstein Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prm Yr HH Add R (PRMHHADR), #26033 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/30/2008 to 05/30/2009 Pass Cancellation)
Cancel Reason: Doesn't use enough, and realized that didn't have to be member to take classes
G/L Code Description Acc ount Number Cst Cntr Descri Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 1040.00 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.
RECEIVED
JUN 1 1 2008
BY:
Page 1
PASS REFUND RECEIPT
Receipt 120778
Payment Date: 05/30/08
Household 7972
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 05/30/08 14:16:38 by LVA FEES CHANGED ON CANCELLED ITEMS 1,040.00
DISCOUNT APPLIED AGAINST CANCELLED FEES O 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET; =UNT,';FROM G ANC EILLE DATE A+IS
TDTALw'AMOUNT:.REFU.NDED
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 1,040.00 Made By JOURNAL -RF 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
issyie o cash or credit card refunds.
Authorized Signature Date Authorized Signature Date
RE C 7 VE JUN 1
BY:
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.
Holstein, Natalie Terms
11748 Shadowwood Crt Date Due
Zionsville, IN 46077
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5130/08 120778 Refund 1,040.00
Total 1,040.00
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-'l 1-10-1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
Holstein, Natalie Allowed 20
11748 Shadowwood Crt
Zionsville, IN 46077
In Sum of
1,040.00
-�N ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 120778 4358400 1,040.00 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
18 -Jun 2008
Signature
$1 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund