161033 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: T361465 Page 1 of 1
ONE CIVIC SQUARE ANDREW POLLEN
0 CHECK AMOUNT: $34.83
CARMEL, INDIANA 46032 6033 WHITE BIRCH DR
FISHERS IN 46038 CHECK NUMBER: 161033
CHECK DATE: 6/25/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 34.83 PARKS DEPARTMENT REFU
i
PASS REFUND RECEIPT
Receipt 123410
Payment Date: 06/03/2008
Household 4832
Home Phone: (317)585 -0788
Work Phone: (317)688 -2765
ANDREW POLLEN Monon Center
6033 WHITE BIRCH DRIVE Carmel IN 46032
FISHERS IN 46038
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 34.83
Pass Holder: Andrew Pollen Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prem. Yrly Ad N (PRMYRADN), #376 535.17 0.00 535.17 0.00 0.00
Valid Dates: 04/15/2007 to 06/30/2008 Pass Cancellation)
Fee Details: Fee Description Amount Count Dis count Sales Tax Total Fee
Prem. Yearly Adult N 535.17 1.00 0.00 0.00 535.17
Cancel Reason: New gym
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 34.83 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 06/03/08 05:15:23 by LVA FEES CHANGED ON CANCELLED ITEMS 34.83
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
JUN 1 1 2008 ;NET AMOUNT FROM CANCELLED ITEMS 34:83
TOTAL AMOUNT.REFUNDED 14.83"
BY:
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 34.83 Made By JOURNAL -RF 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
issue ?No ash or credit card refunds.
Authorized Signature Date Authorized Signature Date
y 3S
n CU.A_�— rC, 6'' Nv 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.
Pollen, Andrew Terms
6033 White Birch Dr Date Due
Fishers, IN 46038
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/3/08 123410 Refund 34.83
P
Total 34.83
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.
Pollen, Andrew Allowed 20
6033 White Birch Dr
Fishers, IN 46038
In Sum of
34.83
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1047 123410 4358400 34.83 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
18 -Jun 2008
Signature
34.83 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund