157069 03/05/2008 CITY OF CARMEL, INDIANA VENDOR: T360909 Page 1 of 1
ONE CIVIC SQUARE MATTHEW GALBRAITH CHECK AMOUNT: $64.00
CARMEL, INDIANA 46032 1818 MARTINDALE ROAD
GAYLORD MI 49735 CHECK NUMBER: 157069
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CHECK DATE: 3/5/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
`1047 4358400 64.00 PARKS DEPARTMENT REFU
t
i
Carmel Clay
Parks &Rec reation CHECK REQUEST
Date:
FEB 2 1 2008
Check payable to BY: 3
Name: N\C��Q
Address: I 1 "4 A cl iZ Cl
City, State, Zip A CI-4 3 S
Mail check to payee Return check to requestor
VzIY
Check Amount Date Required
Check needed for Q Q 1'^ ,x r.-P n� l U Ll� CA
A D tJ C j
Supporting documentation or receipt(s) MUST be attached.
To be paid from
PO
Budget account GL U `4 v`LT
Budget Line Description
n\
Requested by (print):
Requested by (signature):
Approved by (signature of Division Manager):
on this date
Form revised 1 -21 -08
PASS REFUND RECEIPT
4
Receipt 93989
Payment Date: 02/18/2008
Household 10139
Home Phone: (317)071 -1197
Work Phone:
MATTHEW GALBRAITH Monon Center
426 OAK DRIVE Carmel IN 46032
CARMEL, IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 64.00
Pass Holder: Matthew Galbraith Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prem. Yrly Ad R (PRMYRADR), #11610 192.00 0.00 192.00 0.00 0.00
Valid Dates: 07/10/2007 to 07/10/2008 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Prem. Yearly Adult R 192.00 1.00 0.00 0.00 192.00
G/L C ode Description Acco Number Cst Cntr Descri Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 64.00 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 02/18/08 15:37:36 by EDR FEES CHANGED ON CANCELLED ITEMS 64.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT; FROWCANCELEED,'"ITEMS 64.00
TOTAL AMOUNT REFUNDED „,L: 64;00"
NEW NET HOUSEHOLD BALANCE 0.00
Refund Type: Refund from Finance
Refund of 64.00 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
i�s6te� No cash or credit card refunds.
e nature Date Authorized Signature Date
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.
Matthew Galbraith Terms
1818 Martindale Rd. Date Due
Gaylord, MI 49735
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/18/08 93989 Refund 64.00
EEEEEEEE E E ETota41$E E E6 4 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.
Matthew Galbraith Allowed 20
1818 Martindale Rd.
Gaylord, MI 49735'
In Sum of
64.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept
1047 93989 4358400 64.00 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
28 -Feb 2008
Signature
64.00 Business Services Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund