169433 03/04/2009 CITY OF CARMEL, INDIANA VENDOR: 362605 Page 1 of 1
s ONE CIVIC SQUARE JIM FOX
CARMEL, INDIANA 46032 5243 WOOD CREEK CT CHECK AMOUNT: $42.20
CARMEL IN 46033 CHECK NUMBER: 169433
CHECK DATE: 3/4/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4358400 227202 42.20 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 227202
Payment Date: 02/13/2009
Household 2662
Home Phone: (317)581 -0940
Work Phone:
JIM FOX Monon Center
5243 WOOD CREEK CT Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Oria Bal Refund New Bal
Module: Pass Management 42.20- 42.20 0.00
G /.L_Cod_e Description Account Number Cs_t_Cntr___.. Description_.._.______.______ Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 42.20 DR
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 42.20
Processed on 02/13/09 07:47:46 by JAS NEW REFUND AMOUNT 42.20
TOTAL REFUNDABLE AMOUNT 42.20
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 42.20 Made By REFUND FINAN With Reference check refund
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
iss ed. cash or credit card refunds.
Au t z d Signature Date Authorized Signature Dale
Page 1
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.
Fox, Jim Terms
5243 Wood Creek Ct Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/13/09 227202 Refund 42.20
Total 42.20
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.
Fox, Jim Allowed 20
5243 Wood Creek Ct
Carmel, IN 46033
In Sum of
42.20
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members
Dept
1046 227202 4358400 42.20 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
26 -Feb 2009
Signature
42.20 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund