167681 01/07/2009 CITY OF CARMEL, INDIANA VENDOR: 362347 Page 1 of 1
ONE CIVIC SQUARE FORREST POWELL CHECK AMOUNT: $128.00
s �'o CARMEL, INDIANA 46032 3046 BUSH PARKWAY
•M ro �.�a CARMEL IN 46033 CHECK NUMBER: 167681
CHECK DATE: 1/7/2009
DEPARTMENT ACCOUN PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 207303 128.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 207303
Payment Date: 12/08/2008
Household 16562 1 g Z�0$
Home Phone: (317)810 -9976
Work Phone: 317
FORREST POWELL Monon Center
3046 BUSH PARKWAY Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
MEMBERSHIP CHANGE Refund Of 128.00
Pass Holder: Forrest Powell Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prem. Yrly Ad R (PRMYRADR), #29896 192.00 0.00 192.00 0.00 0.00
Valid Dates: 03/07/2008 to 03107/2009 Pass Change)
Auto -Debit Details: 9 Current/Previous Bill(s) Totaling $288.00 2 Future Bill(s) Totaling $64.00
Final Cumulative Fees Totaling $256.00
Fee Details: Fee De Amount Count Discount Sales Tax Total Fee
Prem. Yearly Adult R 192.00 1.00 0.00 0.00 192.00
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 128.00 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
Processed on 12/08/08 15:57:58 by EMB FEES ADJUSTED ON CHANGED ITEMS 128.00
DISCOUNT APPLIED AGAINST THESE FEES O 0.00
SALES TAX CHARGED ON CHANGED FEES 0.00
NET AMOUNT FROM ;CHANGED'ITEMSOu =;°;128`.00-
TOTALAMOUNT:REFUNDED_, VNX 121300;
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 128.00 Made By REFUND FINAN With Reference
Ali 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.
Authorize Signature Date Authorized Signature Date
1' �v� Page 1
i 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,
Terms
Powell, Forrest
Data Due
3046 Bush Parkway
Carmel, IN 46033
Invoice Invoice Description
j(or no te attached invoices) or bill(s)) Amount
Date Number 128.00
1218108 207303 Refund
Total 128.00
I hereby certify that the attached invoice(s), or bills) 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.
Powell, Forrest Allowed 20
3046 Bush Parkway
Carmel, IN 46033
In Sum of
128.00
rE
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
�PO# or, INVOICE NO, ACCT #1TITLC AMOUNT Board Members
Dept
1047 207303 4358400 128.00 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
19 -Dec 2008
Signature
128.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund