156251 02/06/2008 CITY OF CARMEL, INDIANA VENDOR: T360821 Page 1 of 1
ONE CIVIC SQUARE CYNTHIA MALLINGER
0
CARMEL, INDIANA 46032 5276 ARAPAHO WAY CHECK AMOUNT: $157.77
CARMEL IN 46033 CHECK NUMBER: 156251
CHECK DATE: 2/6/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 86756 157.77 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
.ecoipt 86756
ayment Date: 01/21/2008 RECEIVED
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ousehold 7764
om6 Phone: (317)569 -1644
Jork Phone: JAN 3 2008
BY: ZIl z t;l cw1 r�o
CYNTHIA MALLINGER Monon Center
5276 ARAPAHO WAY Carmel IN 46032
CARMEL, IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
'ass Details
CANCELLATION Refund Of 157.77
Pass Holder: Cynthia Mallinger Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly GF Res Unli (YGFRU), #14321 92.23 0.00 92.23 0.00 0.00
Valid Dates: 09/08/2007 to 09/08/2008 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yearly GF Res Unlimi 92.23 1.00 0.00 0.00 92.23
Cancel Reason: degenerative disk disease, can not participate
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 157.77 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 01/21/08 13:57:15 by CEK FEES CHANGED ON CANCELLED ITEMS 157.77
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROMaCANCELLED'ITEMS 157 77
TOTAL --AMOUNT.REFUNDEDa 157 -77`''
NEW NET HOUSEHOLD BALANCE 0.00
Refund Type: Refund from Finance
Refund of 157.77 Made By JOURNAL -RF With Reference
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 w eks to process. A check will be
issued. No cash or credit card refunds.
Authorized Signature
J Date 'Ruth sized igna re Da
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.
Cynthia Mallinger Terms
5276 Arapaho Way Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/21/08 86756 Refund 157.77
Total 157.77
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.
Cynthia Mallinger Allowed 20
5276 Arapaho Way
Carmel, IN 46033
In Sum of
157.77
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 86756 4358400 157.77 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
30 -Jan 2008
Sign �JManaqer
157.77 Business Se
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund