164308 09/30/2008 CITY OF CARMEL, INDIANA VENDOR: T361905 Page 1 of 1
ONE CIVIC SQUARE SANDEE KLEYMEYER CHECK AMOUNT: $407.43
CARMEL, INDIANA 46032 13561 LANDSER CT
CARMEL IN 46033
CHECK NUMBER: 164308
CHECK DATE: 9/30/2008
DEPARTMENT ACCOUNT PO N INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 407.43 REFUNDS AWARDS INDE
PASS REFUND RECEIPT.
Receipt 181440 R ECE1VFD
Payment Date: 08/28/2008
Household 4740
Home Phone: (317)844 -2414 SEP 2 3 ?n08
Work Phone: (317)
BY:
SANDEE KLEYMEYER Monon Center
13561 LANDSER CT. Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION, Refund Of 191.77
Pass Holder. Sandee Kleymeyer Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly GF Res Unli (YGFRU), #26870 58.23 0.00 58.23 0.00 0.00
Valid Dates: 06/04/2008 to 06/04/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yearly GF Res Unlimi mm 58.23 1.00 0.00 0.00 58.23
Cancel Reason: recuperating from surgery on fractured fibula
CANCELLATION Refund Of 215.66
Pass Holder: Sandee Kleyrneyer Fees Tax Discount Prev Paid Cur Paid Amount-Due
Pass Type: Yly FT Alt Res (YFTAR), #31085 24.34 0.00 24.34 0.00 0.00
Valid Dates: 07/22/2008 to 07/22/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yearly f=itness Adult 24.34 1.00 0.00 0.00 24.34
Cancel Reason: recuperating from surgery on fractured fibula
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 407.43 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 08/28/08 05:21:09 by RDG FEES CHANGED ON CANCELLED ITEMS 407.43
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
(AEMAINOUNTFROM'CANCELLED ITEMS �)F ==l
�TOTAL.AIMOU.NT,:REF,UNDED.
Page 1
PASS REFUND RECEIPT
Receipt 181440
Payment Date: 08/28/08
Household 4740
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 407.43 Made By REFUND FINAN With Reference sandee kleymeyer
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issu o sh or credit card refunds.
Authorized Signature Date Authorized Signature Date
Li3
Page 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.
Kleymeyer, Sandee Terms
13561 Landser Ct Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/28108 181440 Refund 407.43
Total 407.43
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.
Kleymeyer, Sandee Allowed 20
13561 Landser Ct
ti Carmel, IN 46033
In Sum of
407.43
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1047 181440 4358400 407.43 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
24 -Sep 2008
Signature
407.43 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund