HomeMy WebLinkAbout168925 02/17/2009 CITY OF CARMEL, INDIANA VENDOR: T362558 Page 1 of 1
ONE CIVIC SQUARE TROY COCKRUM CHECK AMOUNT: $20.00
CARMEL, INDIANA 46032 10810 A N COLLEGE AVE
INDIANAPOLIS IN 46280 CHECK NUMBER: 168925
CHECK DATE: 2/17/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
1047 4358400 216383 20.00 REFUNDS AWARDS INDE
I
PASS REFUND RECEIPT
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Receipt 216383
Payment Date: 01/09/2009
Household 13701
Home Phone: (317)473 -4938
Work Phone: (317)
TROY COCKRUM Monon Center
10810 A N COLLEGE AVE Carmel IN 46032
INDIANAPOLIS IN 46280
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 20.00
Pass Holder: Troy Cockrum Fees +Tax Discount Prev Paid Cur Paid Amount Due
0.00 20.00 0.00
Pass Type: Yly FT Alt Res (YFTAR), #16503 20.00 0.00
Valid Dates: 11/03/2008 to 11/19/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yearly Fitness Adult 20.00 1.00 0.00 0.00 20.00
Cancel Reason: didn't use enough /pass should have been cancelled a month earlier
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 20.00 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
FEES CHANGED ON CANCELLED ITEMS 40.00
Processed on 01/09/09 12:30:10 by SLR
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 20.00
NET'AMOU NT, FROM .CANCELLED "ITEMS 20:00=
TOTAL AMOUNT REFUNDED 77z 20 €00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 20.00 Made By REFUND FINAN With Reference refunding december
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.
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Authorized Signature Date Authorized Signature Date
Page 1
A ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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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.
Cockrum, Troy Terms
10810 A N College Ave Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/9109 216383 Refund 20.00
Total 20.00
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
,20
Clerk- Treasurer
Voucher No. Warrant No.
Cockrum, Troy Allowed 20
10810 A N College Ave
pot Indianapolis, IN 46280
In Sum of
20.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members
Dept
1047 216383 4358400 20.00 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
13 -Feb 2009
Signature
20.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund