HomeMy WebLinkAbout165417 10/29/2008 f CITY OF CARMEL, INDIANA VENDOR: T362062 I t; Page 1 of 1
1J ONE CIVIC SQUARE TIRAJEH SAADATZADEH CHECK AMOUNT: $20.00
CARMEL, INDIANA 46032 457 AUTUMN DR
CARMEL IN 46032 CHECK NUMBER: 165417
CHECK DATE: 10/29/2008
DEPARTMENT ACCOUNT PO NUMBE I NVOICE NUM AMOUN D
1047 4358,400 191191 20.00 REFUNDS AWARDS INDE
i
PASS REFUND
Receipt 191191
Payment Date: 10/02/2008
Household 409
Home Phone: (317)843 -1294 O 4 2008
Work Phone: (317)278 -4874
BY:
Sckada.( cWdq Ti 1(
700002291 BIJANGI Monon Center
457 AUTUMN DR. Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Detaiis
CANCELLATION Refund Of 20.00
Pass Holder: Tirajeh Saadatzadeh Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #24425 80.00 0.00 0.00 80.00 0.00
Valid Dates: 05/05/2008 to 05/05/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yearly Fitness Adult 80.00 1.00 0.00 0.00 80.00
Cancel Reason: Not using anymore
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
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 10/02/08 11:37:19 by EMB FEES CHANGED ON CANCELLED ITEMS 100.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 80.00-
11 NETg'AMOUNT FROM
TOTAL AMOUNT REFUNDED 20:00.
NEW NET HOUSEHOLD BALANCE 20.00
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
issued. No cash or credit card refunds.
OLM� 1 6/ a, J J
Authorized Signature Date Authorized Signature Date
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6 Page 1
ACCOUNTS PAYABLE VOUCHER
CITY OF CAMEL`
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.
Saadatzadeh, Tirajeh Terms
457 Autumn Dr Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/2/08 191191 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
20_
Clerk- Treasurer
Voucher No. Warrant No.
Saadatzadeh, Tirajeh Allowed 20
457 Autumn Dr
Carmel, IN 46032
In Sum of
20.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 191191 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
14 -Oct 2008
Signature
20.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund