174329 07/08/2009 a -F4, CITY OF CARMEL, INDIANA VENDOR: 363032 Page 1 of 1
ONE CIVIC SQUARE ANDREW GRSKOVICH
1544 QUEENSBOROUGH DRIVE CHECK AMOUNT: $45.00
CARMEL, INDIANA 46032
CARMEL IN 46033 CHECK NUMBER: 974329
CHECK DATE: 718/2009
DEPARTMENT A PO NUMBE INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 1047 45.00 REFUNDS AWARDS INDE
01
ACTIVITY REFUND RECEIPT
Re§eipt 287093
Payment Date: 06/26/2009
Household 3499;
H Phone: (317)574 -2729 t; JUL 0 2 2009
Work Phone:
ANDREW GRSKOVICH Monon Center
1544 QUEENSBOROUGH DR Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 45.00
Enrollee Name: Marian GrskOVich Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 196368 -03 Cheerleading 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 04/0512009 (Cancelled)
Primary Instructor: Tumble Time
Class Location: Party Rooms A B Class Dates: 07/08/2009 to 07/29/2009
Monon Center 5:OOP to 5:45P
W
Carmel, IN 46032 Scheduled Sessions: 4
(317)848 -7275
Fee Details: Fee Descri Amount Count. Discount Sales Tax Total Fee
Cheerleading 7.00 1.00 0.00 0.00 7.00
Cancel Reason: different cheerleading class
GIL Code Description Account Number Cst C ntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control.Acct here 45.00 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 06/26/09 09:35:35 by LVA FEES CHANGED ON CANCELLED ITEMS 52.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 7.00
NET AMOUNT FROM CANCELLED ITEMS 45.00-
TOTAL AMOUNT REFUNDED
NEW NET HOUSEHOLD BALANCE 0.00
Page 1
ACTIVITY REFUND RECEIPT
Receipt 287093
Payment Date: 06/26/2009
Household 3499
Refund of 45.00 Made By REFUND FINAN With Reference taking different cla
Rewards Points refunded on this receipt: 0.70
Household Reward Point Balance: 0.70
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.
&Ob/ T k �7
Authorized S' n ture Date Authorized Signature Date
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it, q�� �q6o
Page 2
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.
Grskovich, Andrew Terms
1544 Queensborough Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6126109 287093 Refund 45.00
Total 45.00
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.
Grskovich, Andrew Allowed 20
1544 Queensborough Dr
Carmel, IN 46033
In Sum of
45.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 287093 4358400 45.00 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
2 -Jul 2009
�0%11 Ar
Signature
45.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund