157374 12/23/2008 CITY OF CARMEL, INDIANA VENDOR: T362319 Page 1 of 1
ONE CIVIC SQUARE DEBORAH KIRKPATRICK
CARMEL, INDIANA 46032 3040 W 76TH STREET CHECK AMOUNT: $30.40
INDIANAPOLIS IN 46268
CHECK NUMBER: 167374
CHECK DATE: 12/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 211072 30.40 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 211072
Payment Date: 12/18/2008°x' !>f
Household 12333
Home Phone: (317)805 -7076 DEC
Work Phone:
TIT HAMILTON Carmel Clay Parks Recreation
865 T CARMEL DRIVE #110 1235 Central Park Drive East
CARMEL N 46032 Carmel IN 46032
C Phone: (317)848 -7275
n Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 30.40
Pass Holder: Deborah Kirkpatrick Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prem. Yrly Ad R (PRMYRADR), #14730 0.00 0.00 0.00 0.00 0.00
Valid Dates: 10/03/2008 to 10/03/2009 Pass Change)
Auto -Debit Details: 13 Current/Previous Bill(s) Totaling $395.20 9 Future Bill(s) Totaling $273.60
Final Cumulative Fees Totaling $273.60
Fee Details: Fee Descri Amount Count Discount Sales Tax Total Fee
Prem. Yearly Adult R 0.00 1.00 0.00 0.00 0.00
GIL Code Descri Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 30.40 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 12/18/08 14:12:43 by ABK FEES ADJUSTED ON CHANGED ITEMS 30.40
DISCOUNT APPLIED AGAINST THESE FEES 0.00
SALES TAX CHARGED ON CHANGED FEES 0.01C
NETAMOUNT'FROMCHANGEDITEMS 30.40-
TOTALAMOUNT REFUNDED 30:40
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 30.40 Made By REFUND FINAN With Reference Auto bill error
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.
Authorized Signature Date Authorized Signature Date
z�� D
Page 1 s a 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.
Kirkpatrick, Deborah Terms
3040 West 76th Street Date Due
Indianapolis, IN 46268
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/18108 211072 Refund 30.40
Total 30.40
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.
Kirkpatrick, Deborah Allowed 20
3040 West 76th Street
Indianapolis, IN 46268
In Sum of
30.40
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members
Dept
1047 211072 4358400 30.40 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 -Dec 2008
pl�L� �L)Z)
Signature
30.40 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund