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Home My WebLink About164659 10/16/2008 CITY OF CARMEL, INDIANA VENDOR: T361990 Page 1 of 1 ONE CIVIC SQUARE MARY AGNES COLBERT CARMEL, INDIANA 46032 1230 SELKIRK LANE CHECK AMOUNT: $87.00 INDIANAPOLIS IN 46260 CHECK NUMBER: 164659 CHECK DATE: 10/16/2008 DEPARTMENT AC COUN T PO NUMBER INVO NUMBER A DESCRIPTION 1047 4358400 87.00 REFUNDS AWARDS INDE ij sm J I e. s? PASS REFUND RECEIPT Receipt# 192209 Payment Date: 10/06/2008 D Household 10227 Home Phone: 317 374 -6608 1 CT o 72008 Work Phone: �317�374 -6608 MARY AGNES COLBERT Monon Center 1 F Carmel IN 46032 rnnnnci rnr ecn47 I X30 2;e1 kirk 1.Qre, Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Pass Details MEMBERSHIP CHANGE Refund Of 40.00 Pass Holder: Mary Agnes Colbert Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Vu AQ Alt Res 10 (VAQAR10), #29858 0.00 0.00 0.00 0.00 0.00 Valid Dates: 07/03/2008 to 12131/2099 Pass Change) Pass Visit Info: Number of Visits: 10 Fee Details: Fee_ Description Amount .._,,,Count Discount Sates Tax Total Fee Value Aquatics Adult 0.00 1.00 0.00 0.00 0.00 MEMBERSHIP CHANGE Refund Of 40.00 Pass Holder: Jeff Adkins Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Vu AQ Alt Res10 (VAQAR10), #29859 0.00 0.00 0.00 0.00 0.00 Valid Dates: 07/03/2008 to 12/31/2099 Pass Change) Pass Visit Info: Number of Visits: 9 Fee Details: Fee Descrip _____Amount Count Discoun Sales Tax Total Fee_ Value Aquatics Adult 0.00 1,00 0.00 0.00 0.00 MEMBERSHIP CHANGE Refund Of 7.00 Pass Holder: Felicia Adkins Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Vu AQ Yth Resl0 (VAQYR10), #29860 18.00 0.00 18.00 0.00 0.00 Valid Dates: 07/03/2008 to 12/31/2099 Pass Change) Pass Visit info: Number of Visits: 8 Fee Details: Fee D Count Discount Sales Tax Fee_ Value Aquatics Youth 18.00 1.00 0.00 0.00 18.00 GIL Cod e_ Descri Account Numbqr C,$t,Cntr De_s.criptmn Accounl_Number Amount 999999 Control Account (AP) Enter Control Accl 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. Page 1 I PASS REFUND RECEIPT Receipt 192209 Payment Date: 10/06/2008 Household 10227 PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 10/06/08 10:55:01 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-: TOTAGAMOUNT 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. '60 A Authoriz d Sig ature Date Authorized Signature Date L 0 t bJ a C.k.'r �m o oH 0 a- e,c s cAn(ellej, +U SS e-S o �-Aec Vo �,-n e e I 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. Colbert, Mary Agnes Terms 1230 Selkirk Lane Date Due Indianapolis, IN 46260 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 10/6/08 192209 Refund 87.00 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 20_ Clerk- Treasurer Voucher No. Warrant No. Colbert, Mary Agnes Allowed 20 1230 Selkirk Lane Indianapolis, IN 46260 In Sum of 87.00 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or Board Members Dept INVOICE NO. ACCT #/TITLE AMOUNT 1047 192209 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 8 -Oct 2008 Signature 87.00 Accounts Payable Coo rdinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund