172977 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 362907 Page 1 of 1
ONE CIVIC SQUARE ERIC PAYNE CHECK AMOUNT: $90.00
CARMEL, INDIANA 46032 13462 SPRING FARMS DRIVE
.r CARMEL IN 46032 CHECK NUMBER: 172977
CHECK DATE: 5/27/2009
DEPARTMENT ACCOUNT PO NUMB INVOICE N UMBE R AMOU DE SCRIPTION
1047 4358400 256907 90.00 REFUNDS AWARDS INDE
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ACTIVITY REFUND RECEIPT
Receipt 256907
Payment Date: 05/08/2009 T
Household 6398 t
Home Phone: (317)569 -9617
Work Phone: MAY 2 1 2009
ERIC PAYNE Monon Center
13462 SPRING FARMS DRIVE Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Orio Bal Refund New Bal
Module: Activity Registration 90.00 90.00 0.00
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 90.00 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 90.00
Processed on 05/08/09 15:46:22 by CNA NEW REFUND AMOUNT 90.00
TOTAL REFUNDABLE AMOUNT 90.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 90.00 Made By REFUND FINAN With Refer rice Creative Art; Low enrollment �({YYlbO
All refunds are subject to State Board of Accounts claim proce u may t ake 4-6 o process. A check will be
issued. No cash or credit card refunds.
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Au orized Signature Date Authorized Signature Date
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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.
Payne, Eric Terms
13462 Spring Farms Drive Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/8/09 256907 Refund 90.00
Total 90.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Payne, Eric Allowed 20
13462 Spring Farms Drive
Carmel, IN 46032
In Sum of
l Ilk.
90.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members
Dept
1047 256907 4358400 90.00 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
21 -May 2009
Signature
Is 90.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund