165402 10/29/2008 CITY OF CARMEL, INDIANA VENDOR: T362060 Page 1 of 1
ONE CIVIC SQUARE DAWN PROVOST
CARMEL, INDIANA 46032 15044 RUTHERFORD DR CHECK AMOUNT: $25.00
WESTFIELD IN 46032 CHECK NUMBER: 165402
CHECK DATE: 10/29/2008
DEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 196195 25.00 REFUNDS AWARDS INDE
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ACTIVITY REFUND RECEIPT
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Receipt 196195
Payment Date: 10/20/2008 OCT 2 1 2oa�
Household 19051 j
Home Phone: (317)669 -7775
Work Phone: (317) B
ti DAWN PROVOST Monon Center
15044 RUTHERFORD DR Carmel IN 46032
WESTFIELD IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 25.00
Enrollee Name: Parker Provost Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 285001 -02 Lil' Dragons TKD Lev 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 08/25/2008 (Cancelled)
Primary Instructor Indy Taekwondo
Class Location: Gymnasium C Class Dates: 11/06/2008 to 12/18/2008
Monon Center 4:30P to 5:OOP
Th
Carmel, IN 46032 Skip Days 11/27/2008
(317)848 -7275 Scheduled Sessions: 6
Fee Details: Fee Description Amount Count Discount Sales Total Fee
Lil' Dragons Tae Kwo 7.00 t00 0.00 0.00 7.00
Cancel Reason: Time won't work out
GIL Code Description Account Number_ Cst Cntr Description Account Number Am_ ount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 25.00 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 10/20/08 14:55:04 by CNA FEES CHANGED ON CANCELLED ITEMS 32.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 7.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 25.00
NEW NET HOUSEHOLD BALANCE 000
Page 4 1
ACTIVITY REFUND RECEIPT
Receipt 196195
Payment Date: 10/2012008
Household 19051
0
Refund of 25.00 Made By REFUND FINAN With Reference time problem
Rewards Points refunded on this receipt: 0.70
Household Reward Point Balance: 22.70
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.
G�DG C
Au orized Signature Date Authorized Signature Date
Page 9 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.
t Provost, Dawn Terms
15044 Rutherford Dr Date Due
s
Westfield, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/20/08 196195 Refund 25.00
Total 25.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No,
Provost, Dawn Allowed 20
15044 Rutherford Dr
Westfield, IN 46032
In Sum of$
25.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 196195 4358400 25.00 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
22 -Oct 2008
Signature
25.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund