166210 11/24/2008 CITY OF CARMEL, INDIANA VENDOR: T362180 P89@ 1 of 1
ONE CIVIC SQUARE MARK FUGATE CHECK AMOUNT: $84.00
CARMEL, INDIANA 46032 86 HAWTHORNE DR
CARMEL IN 46033 CHECK NUMBER: 166210
CHECK DATE: 11/2412008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 199775 84.00 REFUNDS AWARDS INDE
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ACTIVITY REFUND RECEIPT
Receipt 199775
Payment Date: 11/07/2008
Household 13091
Home Phone: (317)574 -9561
1N'ork Phone: (317)285 -4057 NOV 1 2
2008
BY:
MARK FUGATE Monon Center
86 HAWTHORNE DRIVE Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
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Enrollment Details
CANCELLATION Refund Of 42.00
Enrollee Name: Lydia Fugate Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 286362 -04 Basic Self Defense f 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 08/10/2008 (Cancelled)
Primary Instructor: House of Martial Arts
Class Location: Fitness Studio B Class Dates: 11/06/2008 to 12/18/2008
Monon Center 4:OOP to 5:OOP
Th
Carmel, IN 46032 Skip Days 11/27/2008
(317)848 -7275 Scheduled Sessions: 6
Cancel Reason: low enrollment
CANCELLATION Refund Of 42.00
Enrollee Name: Graham Fugate Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 286362 -04 Basic Self Defense f 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 08/10/2008 (Cancelled)
Primary Instructor: House of Martial Arts
Class Location: Fitness Studio B Class Dates: 11/06/2008 to 12/18/2008
Monon Center 4 :OOP to 5:OOP
Th
Carmel, IN 46032 Skip Days 11/27/2008
(317)848 -7275 Scheduled Sessions: 6
Cancel Reason: low enrollment
G/L Code Descri Account Num ber______ Cst Cntr Descri Account Nu mber_ Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 84.00 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.
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ACTIVITY REFUND RECEIPT
Receipt 199775
Payment Date: 11/07/2008
Household 13091
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 11/07/08 11:36:54 by LVA FEES CHANGED ON CANCELLED ITEMS 84.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 84.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 84.00 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
issued. No cash or credit card refunds.
ALaQAn
Authorized i nature Date Authorized Signature Date
L17 '3 W. �00.
S SG 1�et1 c
Low -en rol I wvvi
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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.
Fugate, Mark Terms
86 Hawthorne Drive Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached. invoice(s) or bill(s)) Amount
11/7/08 199775 Refund 84.00
Total 84.00
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.
Fugate, Mark Allowed 20
86 Hawthorne Drive
Carmel, IN 46033
In Sum of
84.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 199775 4358400 84.00 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
K-Z /h Z= 2
Signature
84.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund