165414 10/29/2008 CITY OF CARMEL, INDIANA VENDOR: T362061 Page 1 of 1
ONE CIVIC SQUARE RICHARD ROWAN CHECK AMOUNT: $20.00
CARMEL, INDIANA 46032 10869 CORNELL AVE
INDIANAPOLIS IN 46280 CHECK NUMBER: 165414
CHECK DATE: 10/29/2008
DEPARTMENT ACCOUNT PO NUMBE I NVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 195615 20.00 REFUNDS AWARDS INDE
1
PASS REFUND RECEIPT
FOCT
1V F1
Receipt 195615 2 2008
Payment Date: 10/16/2008
Household 12524
Home Phone: (317)605 -9957
Work Phone: (317)
RICHARD ROWAN Monon Center
10869 CORNELL AVE Carmel IN 46032
INDIANAPOLIS IN 46280
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 20.00
Pass Holder: Richard Rowan Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #42505 0.00 0.00 0.00 0.00 0.00
Valid Dates: 10/13/2008 to 10/13/2009 Pass Change)
Auto -Debit Details: 11 Future Bill(s) Totaling $220.00
Fee Details: Fee Descri Amount Count Discount Sales Tax Total Fee
Yearly Fitness Adult 0.00 1.00 0.00 0.00 0.00
G/L Code Description Account Number Cst Cntr Descri Account Number 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 10/16/08 15:02:31 by EMB FEES ADJUSTED ON CHANGED ITEMS 20.00
DISCOUNT APPLIED AGAINST THESE FEES 0.00
SALES TAX CHARGED ON CHANGED FEES 0.00
1NET =AMOUNTFF.ROWCHANGED" ITEM
S
TOTALaAMOUNT'REFl1NDED `20900 4'
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.
a k, A
Authorized Sign lure Date Authorized Signature Date
1 1 1 0 v�� L 3 L A 0 0 Page 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.
Rowan, Richard Terms
10869 Cornell Ave Date Due
Indianapolis, In 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s))
Amount
10/16/08 195615 Refund 20.00
Total 20.00
I 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.
Rowan, Richard Allowed 20
10869 Cornell Ave
Indianapolis, In 46280
In Sum of
n
20.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 195615 4358400 20.00 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
22 -Oct 2008
Signature
20.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund