165238 10/29/2008 CITY OF CARMEL, INDIANA VENDOR: T362048 Page 1 of 1
ONE CIVIC SQUARE ANDREW GOLDBERG CHECK AMOUNT: $100.00
i:,��t•. CARMEL, INDIANA 46032 1383 PRAIRIE CREEK CT
CARMEL IN 46032 CHECK NUMBER: 165238
CHECK DATE: 10/29/2008
`DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 193083 100.00 REFUNDS AWARDS INDE
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ACTIVITY REFUND RECEIPT
5
Receipt 193083 OCT 1 4 2008
Payment Date: 10/08/2008
Household 21199
Home Phone: (317)816 -2200 BY:
Work Phone:
ANDREW GOLDBERG Monon Center
1383 PRAIRIE CREEK CT Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 5.00
Enrollee Name: Brianne Goldberg Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 286400 -02 Capture the Flag 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 08/15/2008 (Cancelled)
Primary Instructor: CCPR Staff
Class Location: West Park Field Class Dates: 10/17/2008 to 10/17/2008
West Park 5:OOP to 6:00P
2700 W. 116th St. F
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 1
Cancel Reason: Low enrollment
CANCELLATION Refund Of 5.00
Enrollee Name: Taylor Goldberg Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 286400 -01 Capture the Flag 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 08/15/2008 (Cancelled)
Primary Instructor: CCPR Staff
Class Location: West Park Field Class Dates: 10/17/2008 to 10/17/2008
West Park 5:OOP to 6:OOP
2700 W. 116th St. F
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 1
Cancel Reason: Low enrollment
G/L Code Description_ Acco_ unt Number_ Cs_t Cntr_____ Description Account Number A
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 10.00 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 193083
Payment Date: 10/08/2008
Household 21199
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 10/08/08 15:22:18 by LVA FEES CHANGED ON CANCELLED ITEMS 10.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS 10,00-
TOTAL AMOUNT REFUNDED 10.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 10.00 Made By REFUND FINAN 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
issue N4 -cash or credit card refunds.
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Authorized Si n lure Date Authorized Signature Date
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Page 2
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ACTIVITY REFUND RECEIPT
Receipt 192246
Payment Date: 10/06/2008 OCT 4 2008
Household 21199
Home Phone: (317)816 -2200 B Y:
Work Phone:
ANDREW GOLDBERG Monon Center
1383 PRAIRIE CREEK CT Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 20.00
Enrollee Name: Andrew Goldberg Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 286202 -02 Phys Kids 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 08/15/2008 (Cancelled)
Primary Instructor: CCPR Staff
Class Location: Gymnasium B Class Dates: 10/07/2008 to 10/28/2008
Monon Center 11:30A to 12:30P
Tu
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 4
Cancel Reason: low enrollment
G/L Code Descrip Account Nu Cst__Cnt_r___ Description Account Number_______ Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 90.00 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 CREDIT HOUSEHOLD BALANCE 70.00
Processed on 10/06/08 12:50:02 by CNA FEES CHANGED ON CANCELLED ITEMS 20.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT.FROM CANCELLED ITEMS 20.00
HH BALANCE APPLIED TO THIS RECEIPT 70.00
TOTAL AMOUNT REFUNDED 90.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 90.00 Made By REFUND FINAN With Reference low enrollment
Page 1
ACTIVITY REFUND RECEIPT
r Receipt 192246
Payment Date: 10/06/2008
Household 21199
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.
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thorized Signature Date Authorized Signature Date
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.
Goldberg, Andrew Terms
1383 Prairie Creek Ct Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1018/08 193083 Refund 10.00
10/6/08 192246 Refund 90.00
Total 100.00
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.
Goldberg, Andrew Allowed 20
1383 Prairie Creek Ct
Carmel, IN 46032
In Sum of
100.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 193083 4358400 10.00 1 hereby certify that the attached invoice(s), or
1047 192246 4358400 90.00 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
15 -Oct 2008
Signature
100.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund