159516 05/14/2008 CITY OF CARMEL, INDIANA VENDOR: T361273 Page 1 of 1
e, ONE CIVIC SQUARE ANN NOURI CHECK AMOUNT: $161.00
CARMEL, INDIANA 46032 10430 BOSAHAN COURT
CARMEL IN 46032 CHECK NUMBER: 159516
CHECK DATE: 5/14/2008
DEPARTMENT ACCO PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4358400 161.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 111737 R ECEIVED
Payment Date: 04(2912008
Household 17420 APR 2 9 2008
Home Phone: (317)334 -0382
Work Phone:
BY
ANN NOURi Monon Center
10430 BOSAHAN CT. Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 73.50
Enrollee Name: Nathan Nouri Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number. 476009 -05 Skyhawks Sports 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 04116/2008 (Cancelled)
Class Location: Smoky Row Elem Class Dates: 06/09/2008 to 06/13/2008
Smoky Row Elementary 9:OOA to 3:OOP
900 West 136th Street M,Tu,W,Th,F
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 5
Fee Details: Fee Description___ Amount Co_unt Disc _Sales Tax _Total Fee
Skyhawks Sports Resi 7.00 1.00 0.00 0.00 7.00
Cancel Reason: family issues will prohibit the child from participating in camp
CANCELLATION Refund Of 87.50
Enrollee Name: Nathan Nouri Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number. 476009 -24 Skyhawks Sports 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 04/16/2008 (Cancelled)
Class Location: Smoky Row Elem Class Dates: 07(2812008 to 08/01/2008
Smoky Row Elementary 9:OOA to 3:OOP
900 West 136th Street M,Tu,W,Th,F
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 5
Fee Details: Fe_e_ _Amount -----.Count Discount Sales Tax Total Fee_
Skyhawks Sports Resi 7.00 1.00 0.00 0.00 7.00
Cancel Reason: family issues will prohibit the child from participating in camp
F IVED 5 2008
Page 1
ACTIVITY REFUND RECEIPT
Receipt 111737
Payment Date: 04/29/08
Household 17420
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 161.00 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 175.00
Processed on 04/29/08 14:52:09 by JAS FEES CHANGED ON CANCELLED ITEMS 350.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 14.00
NET AMOUNT FROM CANCELLED ITEMS 336.00
HH BALANCE APPLIED TO THIS RECEIPT 175.00
TOTAL AMOUNT REFUNDED 161.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 161.00 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
issued. No cash or credit card refunds.
.�x
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A n e gnature Date Authorized Signature Date
VV CAJ
Duv�/4
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.
Nouri, Ann Terms
10430 Bosahan Ct. Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4129108 11737 Refund 161.00
Total 161.00
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.
Nouri, Ann Allowed 20
10430 Bosahan Ct.
Carmel, IN 46032
In Sum of
161.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1046 11737 4358400 161.00 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
13 -May 2008
Signatu
161.00 Business S i .Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund