169424 03/04/2009 CITY OF CARMEL, INDIANA VENDOR: 362604 Page 1 of 1
s ONE CIVIC SQUARE DAVID FEENEY CHECK AMOUNT: $84.25
?a CARMEL, INDIANA 46032 3160 6ENTWOOD COURT S DR
INDIANAPOLIS IN 46263 CHECK NUMBER: 169424
CHECK DATE: 3/4/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOU DESCRIPTION
1047 4358400 225522 84.25 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 225522
Payment Date: 02/06/2009
Household 15343
Home Phone: (317)503 -3314
Work Phone:
DAVID FEENEY Monon Center
3160 BENTWOOD COURT SOUTH DRIVE Carmel IN 46032
INDIANAPOLIS IN 46268
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION
Pass Holder: Tori Hart Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prm Yr Adult NR (PRMYRADN), #19585 0.00 0.00 0.00 0.00 0.00
Valid Dates: 01/18/2009 to 01/19/2010 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Prem. Yearly Adult N 0.00 1.00 0.00 0.00 0.00
Cancel Reason: Moved, too far to travel to work out
CANCELLATION Refund Of 84.25
Pass Holder: Tori Hart Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly GF Non Unli (YGFNUL), #27616 165.75 0.00 165.75 0.00 0.00
Valid Dates: 06/09/2008 to 06/09/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yealy Group Fitness 165.75 1.00 0.00 0.00 165.75
Cancel Reason: Moved, too far to travel to work out
G/L Code Description Account Number Cst C ntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 8425 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 02/06/09 11:05:20 by RDG FEES CHANGED ON CANCELLED ITEMS 84.25
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT:'FROWCANCELLED9TEMS 84.25-
TiOTAL AMOUNT'REFUNDED 84.25
Page 1
PASS REFUND RECEIPT
Receipt 225522
Payment Date: 02/06/2009
Household 15343
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 84.25 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.
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.
Feeney, David Terms
3160 Bentwood Court S Drive Date Due
Indianapolis, IN 46268
Invoice Invoice Description
Date Number (or note attached invoices) or bill(s)) Amount
216!09 225522 Refund 84.25
Total 84.25
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.
Feeney, David Allowed 20
3160 Bentwood Court S Drive
Indianapolis, IN 46268
In Sum of
84.25
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/T1TLE AMOUNT Board Members
Dept
1047 225522 4358400 84.25 i 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
26 -Feb 2009
Signature
84.25 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund