165241 10/29/2008 CITY OF CARMEL, INDIANA VENDOR: T362050 Page 1 of 1
ONE CIVIC SQUARE WILLIAM GRAFF
CARMEL, INDIANA 46032 CHECK AMOUNT: $80.00
101 2ND AVENUE SW APT 28
CARMEL IN 46032 CHECK NUMBER: 165241
CHECK DATE: 10/29/2008
L, EPARTMENT ACCOUN P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 190680 80.00 REFUNDS AWARDS INDE
�6
PASS REFUND RECEIPT
Receipt 190680
Payment Date: 09/30/2008 =Y:
OCT
Household 20013
Home Phone: (859)420 -4723 I
WA Phone:
WILLIAM GRAFF Monon Center
101 2ND AVENUE S.W. APT 26 Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 80.00
Pass Holder: Jennifer Graff Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: PT 10 hour pack (VPTTEN), #31011 370.00 0.00 370.00 0.00 0.00
Valid Dates: 08/23/2008 to 12/31/2099 Pass Change)
Pass Visit Info: Number of Visits: 3
Fee Details: Fee Description Amount Count Disco Sales Tax Total Fee
Personal Training 10 370.00 1.00 0.00 0.00 370.00
G/L Code Description Account Number Cst Cntr Descr Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 80.00 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 09/30/08 06:37:30 by EMB FEES ADJUSTED ON CHANGED ITEMS 80.00
DISCOUNT APPLIED AGAINST THESE FEES 0.00
SALES TAX CHARGED ON CHANGED FEES 0.00
NETAMOUNT FROM CHANGED ITEMS 80:00.;,
TOTAL` REFUNDED, IVWf _80 '.00.::
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 80.00 Made By REFUND FINAN 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
issued. No cash or credit card refunds.
Awk
Authori ed Signature I Date Authorized Signature Date
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PO (S \I.Q-O Le I (�J 'Page 1
3-13. 12\ 3-x4�
ACCOUNTS PAYABLE VOUCHER
1_ 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
Graff, William Purchase Order No.
101 2nd Avenue, SW Apt 26 Terms
Carmel, IN 46032 Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s))
9/30/08 190680 Refund Amount
80.00
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accord ncceal $0.00
with IC 5- 11- 10 -1.6
,20
Clerk- Treasurer
Voucher No. Warrant No.
Graff, William Allowed 20
101 2nd Avenue, SW Apt 2B
Carmel, IN 46032
In Sum of
80.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 190680 4358400 80.00 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
14 -Oct 2008
AAIZIJIO�
Signature
80.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund