158118 04/01/2008 �F CITY OF CARMEL, INDIANA VENDOR: T361079 Page 1 of 1
ONE CIVIC SQUARE ROBERT SCHOTT
t CARMEL, INDIANA 46032 1028 SARATOGA CIRCLE CHECK AMOUNT: $60.80
'ti� INDPLS IN 46280 CHECK NUMBER: 158118
CHECK DATE: 411/2008
DEPAR ACCOUNT PO NUMBER INVOI N UMBER AMOUNT DESCRIPTION
104;'' 4358400 96527 60.80 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 96527 RECEIVED
Payment Date: 02/28/2008
Household 11577 MAR 2 0 2008
Home Phone: (317)587 -1269
Work Phone:
By:
.f
DELTA FAUCET _.f/r Monon Center
55 EAST 111TH STREET Carmel IN 46032
INDIANAPOLIS, IN 46280
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 60.80
Pass Holder: Robert Schott Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prem. Yrly Ad R (PRMYRADR), #13795 121.60 0.00 121.60 0.00 0.00
Valid Dates: 08/28/2007 to 08/28/2008 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Prem. Yearly Adult R 121.60 1.00 0.00 0.00 121.60
Cancel Reason: Chlorine bothered skin
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 60.80 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 02/28/08 11:01:31 by EDR FEES CHANGED ON CANCELLED ITEMS 182.40
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 121.60
NET AMOUNT,FROM CANCELLED ITEMS 6080
TOTAL,AMOUNT REFUNDED %80
NEW NET HOUSEHOLD BALANCE 0.00
Refund Type: Refund from Finance
Refund of 60.80 Made By JOURNAL -RF With Reference
This refund will be mailed to Robert Schott
1028 Saratoga Circle
Indianapolis, IN 46280
Page 1
PASS REFUND RECEIPT
Receipt 96527
Payment Date: 02/28/08
Household 11577
All refunds are sub'e o State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issu o car cnE card refunds. I No,?
Author d ignature Date Authorized Signature Date
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.
Robert Schott Terms
1028 Saratoga Circle Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/28/08 96527 Refund 60.80
Total 60.80
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Robert Schott Allowed 20
1028 Saratoga Circle
Indianapolis, IN 46280
In Sum of
60.80
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 96527 4358400 60.80 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 -Mar 2008
Signat re
60.80 Business Services Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund