155733 01/23/2008 CITY OF CARMEL, INDIANA VENDOR: T360723 Page 1 of 1
ONE CIVIC SQUARE MYRON GORIN
CARMEL, INDIANA 46032 5807 SEDGEGRASS CROSSING CHECK AMOUNT: $135.00
CARMEL IN 46033 CHECK NUMBER: 155733
CHECK DATE: 1/2312008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 82781 135.00 REFUNDS AWARDS INDE
I
j
ACTIVITY REFUND RECEIPT
Receipt 82781
Payment Date: 01/08/2008
Household 14547
Hgme Phone: (317)571 -1902 f f+_ N� 4 2 1 u
Work Phone: i
X122
MYRON GORIN Carmel Clay Parks Recreation
5807 SEDGEGRASS CROSSING 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 135.00
Enrollee Name: Julia Gorin Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 386316 -01 Dancing Little Star 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 12/29/2007 (Cancelled)
Primary Instructor: Int Talent Academy
Class Location: Dance /Fitness Room Class Dates: 01/11/2008 to 02/29/2008
Monon Center 4:30P to 5:20P
F
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 8
Cancel Reason: low enrollment
G/L Co Desc Account Number C st Cntr Description Acco Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 135.00 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 01/08/08 15:04:49 by BJC FEES CHANGED ON CANCELLED ITEMS 135.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS 135.00•
TOTAL AMOUNT REFUNDED 135.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund Type: Refund from Finance
Refund of 135.00 Made By JOURNAL -RF With Reference low enrollment
Page 1
ACTIVITY REFUND RECEIPT
Receipt 82781
Payment Date: 01/08/08
Household 14547
All refunds are subject to State Board of Accounts claim procedure and m,4y take 440 weeks to process. A check will be
issued. No cash or credit card refunds.
A tlior' ed ignature Date Authorized Si nature Date
L--q,
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.
Myron Gorin Terms
5807 Sedgegrass Crossing Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/8/08 82781 Refund 135.00
Total 135.00
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.
Myron Gorin Allowed 20
5807 Sedgegrass Crossing
Carmel, IN 46033
In Sum of
135.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 82781 4358400 135.00 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
Signature
135.00 Business Servic anager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund