164314 08/30/2008 CITY OF CARMEL, INDIANA VENDOR: T361906 Page 1 of 1
ONE CIVIC SQUARE MELISSA LABORSKY
0 CHECK AMOUNT: $431.91
CARMEL, INDIANA 46032 1460 PRESTWICK LANE
CARMEL IN 46032 CHECK NUMBER: 164314
CHECK DATE: 9/30/2008
DEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMO DESCRIPTION
1047 4358400 431.91 REFUNDS AWARDS INDE
`4
GLOBAL REFUND RECEIPT
Receipt 186389 FIC Payment Date: 09/08/2008 ��T,
Household 5813
Home Phone: (317)218 -3552 S E P 2 3 2008
Work Phone: (317)
BY:
MELISSA LABORSKY Monon Center
1460 PRESTWICK LANE Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 431.91
Pass Holder: Melissa Laborsky Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prem. Yrly HH R (PRMYRHHR), #20719 608.09 0.00 608.09 0.00 0.00
Valid Dates: 02/07/2008 to 02/07/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Prem Yrly HH Res 608.09 1.00 0.00 0.00 608.09
Cancel Reason: Moving out of state.
CANCELLATION
Pass Holder: Jeffrey Laborsky Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prm Yr HH Add R (PRMHHADR), #20720 0.00 0.00 0.00 0.00 0.00
Valid Dates: 02/07/2008 to 02/07/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Prem Yrly HH Add Res 0.00 1,00 0.00 0.00 0.00
Cancel Reason: Moving out of state.
CANCELLATION
Pass Holder: Emma Laborsky Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prm Yr HH Add R (PRMHHADR), #20721 0.00 0.00 0.00 0.00 0.00
Valid Dates: 02/07/2008 to 02/07/2009 Pass Cancellation)
Fee Details: Fee Description A mount Count Discount Sales Tax Total Fee
Prem Yrly HH Add Res 0.00 1.00 0.00 0.00 0.00
Cancel Reason: Moving out of state.
Page 1
GLOBAL REFUND RECEIPT
Receipt 186389
Payment Date: 09/08/08
Household 5813
CANCELLATION
Pass Holder: Katie Williams Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prm Yr HH Add R (PRMHHADR), #20722 0.00 0.00 0.00 0.00 0.00
Valid Dates: 02/07/2008 to 02/07/2009 Pass Cancellation)
Fee Details: Fee Description Amount C ount Discount Sales Tax Total Fee
Prem Yrly HH Add Res 0.00 1.00 0.00 0.00 0.00
Cancel Reason: Moving out of state.
CANCELLATION
Pass Holder: Nicole Bishop Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prm Yr HH Add R (PRMHHADR), #20723 0.00 0.00 0.00 0.00 0.00
Valid Dates: 02/07/2008 to 02/07/2009 Pass Cancellation)
Fee Details: Fee Description Am ount Count Discount Sales Tax Total Fee
Prem Yrly HH Add Res 0.00 1.00 0.00 0.00 0.00
Cancel Reason: Moving out of state.
GIL 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 431.91 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 09/08/08 18:43:02 by CMG FEES CHANGED ON CANCELLED ITEMS 431.91
DISCOUNT APPLIED AGAINST CANCELLED FEES O 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
�NETrAMOUNTiFROMiCANCELLED .;ITEMS 431.97`
TOTAL- ,AMOUNTtREFUNDED 3.6" 431':97 i
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 431.91 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 refund
L
Authorized Signature Date Authorized Signature DT.
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.
Laborsky, Melissa Terms
1460 Prestwick Lane Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/8/08 186389 Refund 431.91
Total 431.91
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.
Laborsky, Melissa Allowed 20
1460 Prestwick Lane
Carmel, IN 46032
In Sum of
431.91
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#fTITLE AMOUNT Board Members
Dept
1047 186389 4358400 431.91 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
24 -Sep 2008
Signature
431.91 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund