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163404 09/03/2008 CITY OF CARMEL, INDIANA VENDOR: T361776 Page 1 of 1 ONE CIVIC SQUARE CARRIE SMITH CARMEL, INDIANA 46032 461 AUTUMN DR CHECK AMOUNT: $196.00 CARMEL IN 46032 CHECK NUMBER: 163404 CHECK DATE: 9/3/2008 DEPARTMENT ACCOUNT PO NUMB INV OICE NUMB AM OUNT DESCRIPTION 1047 4358400 178373 196.00 REFUNDS AWARDS INDE ACTIVITY REFUND RECEIPT 1 �C I �F Receipt 178373 AUG 2 0 ZOOS Payment Date: 08/18/2008 Household 21179 Home Phone: (317)201 -8622 BY' Work Phone: CARRIE SMITH Monon Center 461 AUTUMN DR Carmel IN 46032 CARMEL IN 46032 Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Enrollment Details CANCELLATION Refund Of 98.00 Enrollee Name: Carrie smith Fees Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 287364 -01 Ballroom Dancing 0.00 0.00 0.00 0.00 0.00 Enrollment Date: 08/14/2008 (Cancelled) Primary Instructor: Rob Jenkins Class Location: Fitness Studio B Class Dates: 09/12/2008 to 11/07/2008 Monon Center 8:OOP to 9:OOP F Carmel, IN 46032 Skip Days 10/31/2008 (317)848 7275 Scheduled Sessions: 8 Cancel Reason: personal reason CANCELLATION Refund Of 98.00 Enrollee Name: bernie smith Fees Tax Discount Prev Paid Cur Paid Amount Due Activity Number: 287364 -01 Ballroom Dancing 0.00 0.00 0.00 0.00 0.00 Enrollment Date: 08/14/2008 (Cancelled) Primary Instructor: Rob Jenkins Class Location: Fitness Studio B Class Dates: 09/12/2008 to 11/07/2008 Monon Center 8:OOP to 9:OOP F Carmel, IN 46032 Skip Days 10/31/2008 (317)848 -7275 Scheduled Sessions: 8 Cancel Reason: personal reason G /L_Cod_e_ Description_ Account_Number_ C_st_Cntr_ Description--------------_- Account Number_.____ ___Amount 999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 196.00 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. Page 1 ACTIVITY REFUND RECEIPT Receipt 178373 Payment Date: 08/18/08 Household 21179 PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 08/18/08 09:31:47 by MML FEES CHANGED ON CANCELLED ITEMS 196.00 DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00 SALES TAX CHARGED ON CANCELLED FEES 0.00 NET AMOUNT FROM CANCELLED ITEMS 196.00- TOTAL AMOUNT REFUNDED 7T 96 00 NEW NET HOUSEHOLD BALANCE 0.00 Refund of 196.00 Made By REFUND FINAN With Reference personal reason All refun e s ect.t State oard of Accounts claim procedure and may take 4 -6 weeks to process. A check will be issu l o fire t car efunds. Auth n Si nature D to Authorized Signature Date 0 1- 7, 3 F 7' 00 5 f/JI 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. Smith, Carrie Terms 461 Autumn Dr Date Due Carmel, IN 46032 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 8/18/08 178373 Refund 196.00 Total 196.00 i 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. Smith, Carrie Allowed 20 461 Autumn Dr Carmel, IN 46032 In Sum of 196.00 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1047 178373 4358400 196.00 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 25 -Aug 2008 Signature 196.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund