161059 06/25/2008 i
CITY OF CARMEL, INDIANA VENDOR: 361466 Page 1 of 1
ONE CIVIC SQUARE ADAM ROHN
CARMEL, INDIANA 46032 1129 ALBEMARIE CIRCLE CHECK AMOUNT: $60.00
s' �o NOBLESVILLE IN 46062 CHECK NUMBER: 161059
CHECK DATE: 6/25/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 60.00 PARKS DEPARTMENT REFU
i
ACTIVITY REFUND RECEIPT
1
Receipt 132174
Payment Date: 06/15/2008
Household 18222
Home Phone: (317)774 -0989
Work Phone: (317)575 -8804
ADAM ROHN Carmel Clay Parks Recreation
1129 ALBEMARLE CIR 1235 Central Park Drive East
NOBLESVILLE IN 46062 Carmel IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 60.00
Enrollee Name: Lauren Rohn Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 186224 -03 Beautiful Ballerina 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 05/13/2008 (Cancelled)
Primary Instructor: Dance Class Studio
Class Location: Dance Studio Class Dates: 06/17/2008 to 08!05/2008
Monon Center 4:30P to 5:OOP
Tu
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 8
Cancel Reason: IOW enrollment
G/L Code Description Acco Number Csl Cntr Descri Account N Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 60.00 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 06/15/08 21:26:49 by CNA FEES CHANGED ON CANCELLED ITEMS 60.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT.FROM CANCELLED ITEMS 60.00-
TOTAL AMOUNT REFUNDED: 60.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 60.00 Made By JOURNAL -RF With Reference low enrollment
Page 1
ACTIVITY REFUND RECEIPT
Receipt 132174
Payment Date: 06/15/08
Household 18222
All refunds are subject to State Board of Accounts claim procedure and ma ke 4 -6 eeks o process. A check will be
issued. No cash or credit card refunds.
1
i90 15
Authorized Signature Date Authorized Signature D to
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.
Rohn, Adam Terms
1129 Albemarle Cir Date Due
Noblesville, IN 46062
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6115108 132174 Refund 60.00
Total 60.00
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
Rohn, Adam Allowed 20
1129 Albemarle Cir
Noblesville, IN 46062
In Sum of
60.00
•4,
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #f AMOUNT Board Members
Dept
1047 132174 4358400 60.00 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
60.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund