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Home My WebLink About164308 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