166307 11/24/2008 I.
a CITY OF CARMEL, INDIANA VENDOR: T362186 Page 1 of 1
ONE CIVIC SQUARE GREGORY MEDLEY CHECK AMOUNT: $87.00
CARMEL, INDIANA 46032 5808 BLUESTEM CT
CARMEL IN 46033 CHECK NUMBER: 166307
CHECK DATE: 11/24/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DE SCRIPTION
1047 4358400 198873 87.00 REFUNDS AWARDS INDE
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PASS REFUND RECEIPT
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Receipt 198873 7N0 2 208Payment Date: 11/03/2008 Household 13968
Home Phone: (317)844 -0590
Work Phone: (317)
GREGORY MEDLEY Monon Center
5808 BLUESTEM CT Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 87.00
Pass Holder: Gregory Medley Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prem. Yrly HH R (PRMYRHHR), #27958 261.00 0.00 261.00 0.00 0.00
Valid Dates: 06/12/2008 to 06/12/2009 Pass Change)
Auto -Debit Details: 3 Current/Previous Bill(s) Totaling $261.00 7 Future Bill(s) Totaling $609.00
Final Cumulative Fees Totaling $870.00
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Prem Yrly HH Res 261.00 1.00 0.00 0.00 261.00
G/L Code Description Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 87.00 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 11/03/08 14:24:45 by EMB FEES ADJUSTED ON CHANGED ITEMS 87.00-
DISCOUNT APPLIED AGAINST THESE FEES 0.00
SALES TAX CHARGED ON CHANGED FEES 0.00
NET AMOUNT FROM CHANGED ITEMS 87.00=
TOTAL AMOUNT REFUNDED 87.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 87.00 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.
N 10 ors
Authorized Si nature Date Authorized Signature Date
0 0 L l C) 0 Page 1
PASS REFUND RECEIPT
Receipt 198873
Payment Date: 11/03/2008
Household 13968
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.
Medley, Gregory Terms
5808 Bluestem Ct Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/3/08 198873 Refund 87.00
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Total 87.00
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.
Medley, Gregory Allowed 20
5808 Bluestem Ct
Carmel, IN 46033
In Sum of
87.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 198873 4358400 87.00 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
17 -Nov 2008
Signature
87.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund