166388 11/24/2008 CITY OF CARMEL, INDIANA VENDOR: T362192 Page 1 of 1
ONE CIVIC SQUARE GEORGIA SIMMONS
i CHECK AMOUNT: $24.00
CARMEL, INDIANA 46032 808 BENNElT ROAD
o CARMEL IN 46032 CHECK NUMBER: 166388
CHECK DATE: 11/24/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE N AMOUNT DESCRIPTION
1046 4358400 203344 24.00 REFUNDS AWARDS INDE
s ACTIVITY REFUND RECEIPT
Receipt 203344 "l�"��T
Payment Date: 11/19/2008
Household 153
Home Phone: (317)846 -3803 NOV 1 9 2008
Work Phone:
BY_ V
GEORGIA SIMMONS Carmel Elementary
808 BENNETT RD 101 4th Avenue SE
CARMEL IN 46032 Carmel IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 24.00
Enrollee Name: Victoria Simmons Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 486014 -01 Basketball with Char 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 11/13/2008 (Cancelled)
Class Location: Carmel Elem School Class Dates: 11124(2008 to 12/15/2008
CarmelClayParksRec 2:45P to 3:45P
101 4th Avenue SE M
Carmel, IN 46033
(317)848 -7275 Scheduled Sessions: 4
Cancel Reason: E2 class cancelled
G/L Code Description Account Num Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 24.00 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
tssed 11/19/08 08:46:39 by JCM FEES CHANGED ON CANCELLED ITEMS 24.00
DISCOUNT APPLIED AGAINST CANCELLED FEES O 0.00
0 SALES TAX CHARGED ON CANCELLED FEES 0.00
1 ,A J NET AMOUNT FROM CANCELLED ITEMS A l/r�/� TOTAL AMOUNT REFUNDED 24.00
1�� NEW NET HOUSEHOLD BALANCE 0.00
Refund of 24.00 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
issued. No cash or credit card refunds.
Page 1
ACTIVITY REFUND RECEIPT
Receipt 203344
Payment Date: 11/19/2008
Household 153
Authorized Signature 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.
Simmons, Georgia Terms
808 Bennett Rd Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/19108 203344 Refund 24.00
Total 24.00
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.
Simmons, Georgia Allowed 20
808 Bennett Rd
Carmel, IN 46032
In Sum of$
24.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #1TITL AMOUNT Board Members
Dept
1046 203344 4358400 24.00 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
17 -Nov 2008
Signature
24.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund