164794 10/16/2008 F CITY OF CARMEL, INDIANA VENDOR: T358141 'Page 1 of 1
ONE CIVIC SQUARE DENISE KLIMA
CARMEL, INDIANA 46032 14069 HONEY TREE DR CHECK AMOUNT: $42.50
CARMEL IN 46032 CHECK NUMBER: 164794
CHECK DATE: 10/1612008
DEPARTMENT ACCOUNT PO N INVOICE NUMBER AMOUNT DESCRIPTION
X1046 4358400 191235 42.50 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 191235
Payment Date: 10/02/2008
Household 283
Home Phone: (317)566 -1615
Work Phone: (317)
DENISE KLIMA Monon Center
14069 HONEY TREE DR. Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 18.00
Enrollee Name: Ellie Klima Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 486032 -03 3 -D Drawing 0.00 0.00 0.00 0.00 0.00
Enrollment Date. 09/19/2008 (Cancelled)
Class Location: College Wood Elem Class Dates: 10/01!2008 to 10115/2008
College Wood Element 2:45P to 3:45P
12415 Shelbourne Road W
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 3
Cancel Reason: e2 class cancelled due to low enrollment
CANCELLATION Refund Of 18.00
Enrollee Name: Avery Klima Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 486032 -03 3 -D Drawing 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 09/19/2008 (Cancelled)
Class Location: College Wood Elem Class Dates: 10/01/2008 to 10/15/2008
College Wood Element 2:45P to 3:45P
12415 Shelbourhe Road W
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 3
Cancel Reason: e2 class cancelled due to low enrollment
GIL Cod De scription Account Number Cst Cntr Descri Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 42.50 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.
Page 1
ACTIVITY REFUND RECEIPT
Receipt 191235
Payment hate: 10/02/2008
Household 283
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 6.50
Processed on 10/02/08 16:09:09 by BJJ FEES CHANGED ON CANCELLED ITEMS 36.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET;AMOUNT�F.ROM.CANCELLED °ITEMS :`.,;36 00'=
HH BALANCE APPLIED TO THIS RECEIPT 6.50
TOTAL`AMOUNT REFUNDED 42:50
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 42.50 Made By REFUND FINAN With Reference
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issue No cash or cre d refunds.
(Au orized Signature Date Authorized Signature Date
C
1 OCT 0
�i 2Q08
BY:
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.
Klima, Denise Terms
14069 Honey Tree Dr Date Due
Carmel, I N 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1012108 191235 Refund 42.50
Total 42.50
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.
Klima, Denise Allowed 20
14069 Honey Tree Dr
Carmel, IN 46032
In Sum of$
42.50
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #ITITLE AMOUNT Board Members
Dept
1046 191235 4358400 42.50 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
7 -Oct 2008
l
Signature
42.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund