166219 11/24/2008 CITY OF CARMEL, INDIANA VENDOR: T360723 Page 1 of 1
ONE CIVIC SQUARE MYRON GORIN
CARMEL, INDIANA 46032 5807 SEDGEGRASS CROSSING CHECK AMOUNT: $108.00
CARMEL IN 46033 CHECK NUMBER: 166219
CHECK DATE: 11/24/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 197698 108.00 REFUNDS AWARDS INDE
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A
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ACTIVITY REFUND RECEIPT
Receipt 197698
Payment Date: 10/30/2008
HDON7,ehold 14547
Home Phone: (317)571 -1902
Work Phone:
2008
MYRON GORIN Monon Center
5807 SEDGEGRASS CROSSING Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 108.00
Enrollee Name: Julia Gorin Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 286216 -02 Dancing Little Star 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 10/17/2008 (Cancelled)
Primary Instructor: Int Talent Academy
Class Location: Dance Studio Class Dates: 10/31/2008 to 12/19/2008
Monon Center 4:30P to 5:20P
F
Carmel, IN 46032 Skip Days 11/28/2008
(317)848 -7275 Scheduled Sessions: 7
Cancel Reason: Low enrollment
G/L C ode Descript Acco N umber Cst C ntr Description Ac count Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 108.00 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 10/30/08 08:51:00 by LVA FEES CHANGED ON CANCELLED ITEMS 108.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 108.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 108.00 Made By REFUND FINAN With Reference low enrollment
Page 1
ACTIVITY REFUND RECEIPT
Receipt 197698
Payment Date: 10/30/2008
Household 14547
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.
Authorized Si ature Date Authorized Signature Date
47, V- 1.300,
Low -e4l
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.
Gorin, Myron Terms
5807 Sedgegrass Crossing Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/30/08 197698 Refund 108.00
Total 108.00
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.
Gorin, Myron Allowed 20
5807 Sedgegrass Crossing
Carmel, IN 46033
In Sum of
108.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 197698 4358400 108.00 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
17 -Nov 2008
Signature
108.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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