163676 09/17/2008 CITY OF CARMEL, INDIANA VENDOR: T361823 Page 1 of 1
I; ONE CIVIC SQUARE CHRIS KAROLZAK CHECK AMOUNT: $200.00
CARMEL, INDIANA 46032 9330 COBBLESTONE COURT
ZIONSVILLE IN 46077 CHECK NUMBER: 163676
CHECK DATE: 9/1712008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 182044 200.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 182044
Payment Date: 08/29/2008, TVF•D
Household 16996
Home Phone: (317)769 -4508
Work Phone: S E P 0 2 2008
BY:
CHRIS KAROLZAK Monon Center
9330 COBBLESTONE COURT Carmel IN 46032
ZIONSVILLE IN 46077
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 200.00
Pass Holder: Thomas Karolzak Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Private Swim Le (1ON1SWIM), #22836 0.00 0.00 0.00 0.00 0.00
Valid Dates: 04/02/2008 to 04/15/2099 Pass Cancellation)
Pass Visit Info: Number of Visits: 10
Cancel Reason: Parent was disatisfied with instructor.
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 200.00 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 08/29/08 14:23:34 by EMB FEES CHANGED ON CANCELLED ITEMS 200.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS 200,00
TOTAL AMOUNT REFUNDED 200.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 200.00 Made By REFUND FINAN With Reference
All refunds are subject to State Board of Accounts claim procedure an �en ay take 4 -6 we ks to process. A check will be
i ed. No cash or cr d' card refuu'n s.
m oio Y/z
J AOthorized Sign ure Date Authorized Signat re Date
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.
Karolzak, Chris Terms
9330 Cobblestone Court Date Due
Zionsville, IN 46077
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/29/08 182044 Refund 200.00
Total 200.00
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
r
Voucher No. Warrant No.
Karolzak, Chris Allowed 20
9330 Cobblestone Court
Zionsville, IN 46077
In Sum of
200.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 182044 4358400 200.00 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
3 -Sep 2008
Signature
200.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund