155687 01/23/2008 CITY OF CARMEL, INDIANA VENDOR: T360721 Page 1 of 1
ONE CIVIC SQUARE DENISE COMBELLICK
CARMEL, INDIANA 46032 14316 JESSI LANE CHECK AMOUNT: $160.00
CARMEL IN 45033 CHECK NUMBER: 155687
CHECK DATE: 1/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 81311 160.00 REFUNDS AWARDS INDE
I
I
I
ACTIVITY REFUND RECEIPT
Receipt 81311
Payment Date: 01/04/2008
Household 813 T TT
Home Phone: (317)843 -9807
Work Phone: (317)523 -4431
JAN 9 2U "i
DENISE COMBELLICK Carmel Clay Parks Recreation
14316 JESSI LANE 1235 Central Park Drive East
CARMEL, IN 46033 Carmel IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 80.00
Enrollee Name: Catelyn Combellick Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 386229 -02 Intro To Dance 4 -5 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 12/18/2007 (Cancelled)
Primary Instructor: Dance Class Studio
Class Location: Dance /Fitness Room Class Dates: 01/08/2008 to 02/26/2008
Monon Center 12:30P to 1:30P
Tu
Carmel, IN 46032 Skip Days 02/18/2008
(317)848 -7275 Scheduled Sessions: 8
Cancel Reason: low enrollment
CANCELLATION Refund Of 80.00
Enrollee Name: Cydney COmbellick Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 386229 -02 Intro To Dance 4 -5 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 12/18/2007 (Cancelled)
Primary Instructor: Dance Class Studio
Class Location: Dance /Fitness Room Class Dates: 01/08/2008 to 02/26/2008
Monon Center 12:30P to 1:30P
Tu
Carmel, IN 46032 Skip Days 02/18/2008
(317)848 -7275 Scheduled Sessions: 8
Cancel Reason: low enrollment
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 160.00 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
ACTIVITY REFUND RECEIPT
Receipt 81311
Payment Date: 01/04/08
Household 813
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 01/04/08 08:49:22 by BJC FEES CHANGED ON CANCELLED ITEMS 160.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS 160.00
TOTAL AMOUNT REFUNDED 160.00.
NEW NET HOUSEHOLD BALANCE 0.00
Refund Type: Refund from Finance
Refund of 160.00 Made By JOURNAL -RF With Reference low enrollment
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.
Auth ed Signature Date Authonzec� ignature 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.
Denise Combellick Terms
14316 Jessi Lane Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/3/08 81311 Refund 160.00
Total 160.00
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.
Denise Combellick Allowed 20
14316 Jessi Lane
Carmel, IN 46033
In Sum of
160.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 81311 4358400 160.00 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
16 -Jan 2008
Signat e
160.00 Business ,S ces Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund