178694 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 363448 Page 1 of 1
4 +t( ONE CIVIC SQUARE JESSICA GENDRON
CARMEL, INDIANA 46032 513 W MELBOURNE AVE CHECK AMOUNT: $32.00
PEORIA IL 61604 CHECK NUMBER: 178694
CHECK DATE: 10/28/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 347398 32.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 347398
Payment Date: 10/19/2009
Household 11133 OCT 2��9
Home Phone: (217)390 -7556
LYs
JESSICA GENDRON n Carmel Clay Parks Recreation
�'�,3 C�J_ /Ile
1600 ne 1235 Central Park Drive East
Carmel IN 46032
p e4 r r a L Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 32.00
Pass Holder: Jessica Gendron Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prm Yr Adult R (PRMYRADR), #13321 0.00 0.00 0.00 0.00 0.00
Valid Dates: 09/28/2009 to 09/28/2010 Pass Cancellation)
G/L Code Description Account Number Cst Cntr Descri Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 32.00 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 10/19/09 14:27:43 by ABK FEES CHANGED ON CANCELLED ITEMS 32.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS 32.00
TOTAL AMOUNT REFUNDED 32.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 32.00 Made By REFUND FINAN With Reference Renewal error
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.
Authorized Signa re Date Authorized Signature Date
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.
Gendron, Jessica Terms
513 W Melbourne Ave Date Due
Peoria, IL 61604
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/19/09 347398 Refund 32.00
Total 32.00
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.
Gendron, Jessica Allowed 20
513 W Melbourne Ave
Peoria, IL 61604
In Sum of
32.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 347398 4358400 32.00 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 -Oct 2009
615
Signature
32.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund