180409 12/16/2009 CITY OF CARMEL, INDIANA VENDOR: 363650 Page 1 of 1
ONE CIVIC SQUARE UDAYINI DEVARAKONDA CHECK AMOUNT: $60.00
CARMEL, INDIANA 46032 11737 ESTY WAY
CARMEL IN 46033 CHECK NUMBER: 180409
CHECK DATE: 12116/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 60.00 REFUNDS AWARDS INDE
GLOBAL REFUND RECEIPT
Receipt# 360505
Payment Date: 12/07/09
Household 10829
Mop= Center Udayini Devarakonda Hm Ph: (317)816 -2624
Carmel IN 46032 11737 Esty Way Wk Ph: (317)782 -2792
Carmel IN 46033 Cell Ph: (317)345 -7692
Phone: (317)848 -7275 udayini_d @hotmail.com
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 60.00
Pass Holder: Abinay Devarakonda Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Swim Less P 10 (M SWMPRV), #59870 140.00 0.00 0.00 140.00 0.00
Valid Dates: 03/03/2009 to 04/15/2099 Pass Cancellation)
Pass Visit Info: Number of Visits: 10
Cancel Reason: pro -rated request
GIL Code Description Account Nu Csl Cntr Descrip Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 60.00 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(07109 16:17:04 by TCP FEES CHANGED ON CANCELLED ITEMS 200.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 140.00
!NET'AMOUNT;'FROM`CANCEI LED "ITEMS :60.00
TOTAL AMOUNT;REFUNDED 60 ?00'`r<
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 60.00 Made By REFUND FINAN With Reference prorated request
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 Signature Dale Authorized Signature Date
D F I" 1X009
BY:
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.
r`
Payee
Purchase Order No.
Devarakonda, Udayini Terms
11737 Esty Way Date Due
Carmel, IN 46033
Invoice invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1214109 360505 Refund 60.00
Total 60.00
1 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.
Devarakonda, Udayini Allowed 20
11737 Esty Way
rf Carmel, IN 46033
In Sum of
60.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1047 360505 4358400 60.00 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
10 -Dec 2009
-2/A
Signature
Signature
60.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund