164705 10/16/2008 CITY OF CARMEL, INDIANA VENDOR: T361991 Page 1 of 1
ONE CIVIC SQUARE STACIA FLOBERG
CARMEL, INDIANA 46032 3799 BRACKEN CT CHECK AMOUNT: $20.00
CARMEL IN 46033 CHECK NUMBER: 164705
CHECK DATE: 10/16/2008
DEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DESCRIPTION
1046 4358400 193373 20.00 REFUNDS AWARDS INDE
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ACTIVITY REFUND RECEIPT
Receipt 193373
Payment Date: 10/10/2008 RE CEIVE D
Household 14666
Home Phone: (317)844 -5242 T 0 200
Work Phone:
BY:
STACIA FLOBERG Monon Center
3799 BRACKEN CT Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Orio Bal Refund New Bal
Module: Activity Registration 20.00- 20.00 0.00
G__ /L.Code_ Description Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 20.00 DR
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 20.00
Processed on 10/10/08 08:07:21 by JAS NEW REFUND AMOUNT 20.00
TOTAL REFUNDABLE AMOUNT 20.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 20.00 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
is ued cash or credit card refunds.
Au o d ignature Date Authorized Signature Date
VG
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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.
Floberg, Stacia Terms
3799 Bracken Ct Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/10/08 193373 Refund 20.00
Total 20.00
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.
Floberg, Stacia Allowed 20
3799 Bracken Ct
Carmel, IN 46033
In Sum of
20.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 193373 4358400 20.00 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
10 -Oct 2008
Signature
20.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund