171804 04/29/2009 ti CITY OF CARMEL, INDIANA VENDOR: 362799 Page 7 of 9
ONE CIVIC SQUARE LEE COOLIDGE
CARMEL, INDIANA 46032 3917 CASTLE ROCK DRIVE CHECK AMOUNT: $141.00
ZIONSVILLE IN 46077
nn CHECK NUMBER: 171801
CHECK DATE: 4/29/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4358400 250887 141.00 REFUNDS AWARDS INDE
cry
's
el PASS REFUND RECEIPT
Receipt 250887 R Y
Payment Date: 04/16/2009
Household 13324 A P R 16 1009
Home Phone: (317)733 -2964
Work Phone: (317)566 -2119
LEE COOLIDGE Monon Center
3917 CASTLE ROCK DRIVE Carmel IN 46032
ZIONSVILLE IN 46077
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Orio Bal Refund New Bal
Module: Pass Management 141.00- 141.00 0.00
G/L Code Description Account Number Cst Cntr Description Account Numb A mount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 141.00 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 141.00
Processed on 04/16/09 (g 11:50:53 by JAS NEW REFUND AMOUNT 141.00
TOTAL REFUNDABLE AMOUNT 141.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 141.00 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 116cash or credit card refunds.
V,
A of d na ure ate Authorized Signature Date
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Page 4 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.
Coolidge, Lee Terms
_i 3917 Castle Rock Drive Date Due
Zionsville, IN 46077
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s))
Amount
4116109 250887 Refund 141.00
Total 141.00
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.
Coolidge, Lee Allowed 20
3917 Castle Rock Drive
Zionsville, IN 46077
In Sum of
141.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 250887 4358400 141.00 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
22 -Apr 2009
7
Signature
141.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund