179641 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 363596 Page 1 of 1
ONE CIVIC SQUARE JEAN DOUGLASS
CARMEL, INDIANA 46032 4723 BRIARWOOD TRACE CHECK AMOUNT: $20.00
CARMEL IN 46032 CHECK NUMBER: 179641
CHECK DATE: 11/24/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 352033 20.00 REFUNDS AWARDS INDE
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GLOBAL REFUND RECEIPT
Receipt 352033
Payment Date: 11/09/09
Household 23901
Monon Center Jean Douglass Hm Ph: (317)810 -0965
Carmel IN 46032 4723 Briarwood Trace
Carmel IN 46032 Cell Ph:
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 20.00
Enrollee Name: Jean Douglass Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 294730 -01 Core Conditioning 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 08/10/2009 (Cancelled)
Primary Instructor: CCPR Staff
Class Location: Fitness Studio B Class Dates: 11/13/2009 to 11/13/2009
Monon Center 12:15P to 1:15P
F
Carmel, IN 46032 Scheduled Sessions: 1
(317)848 -7275
Cancel Reason: low enrollment
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
Processed on 11/09/09 20:42:39 by LWW FEES CHANGED ON CANCELLED ITEMS 20.00
NET AMOUNT FROM CANCELLED ITEMS 20:00-
TOTAL AMOUNT REFUNDED 20.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 20.00 Made By REFUND FINAN With Reference low enrollment
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 Date Authorized Signature Date
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Nov 1 7 2009
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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.
Douglass, Jean Terms
4723 Briarwood Trace Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/9/09 352033 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.
Douglass, Jean Allowed 20
4723 Briarwood Trace
Carmel, IN 46032
In Sum of
20.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 352033 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
19 -Nov 2009
T
Signature
20.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund