172121 04/30/2009 CITY OF CARMEL, INDIANA VENDOR: 362796 Page 1 of 1
ONE CIVIC SQUARE JAMES BAYNES
CARMEL, INDIANA 46032 1629 CENTAUR CIRCLE CHECK AMOUNT: $27.20
LAFAYETTE CO 80026 CHECK NUMBER: 172121
CHECK DATE: 4/30/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 252086 27.20 REFUNDS AWARDS INDE
i
PASS REFUND RECEIPT
Receipt 252086 D
Payrrent Date: 04/21/2009
Household 11950 A PR
Home Phone: (317)249 -5262 2 1009
E
Work Phone:
ISO MIST L A/ S Car el Clay Parks Recreation
701 Y CENTER 123 Central Park Drive East
ELIN 46032 Car eIIN 46032
Cen r C,!, e, Ph ne: (317)848 7275
��o�.P C Fe Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 27.20
Pass Holder: James Baynes Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prm Yr Adult R (PRMYRADR), #13949 137.60 0.00 0.00 137.60 0.00
Valid Dates: 10/02/2008 to 10/02/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Prem. Yearly Adult R 137.60 1.00 0.00 0.00 137.60
Cancel Reason: Requested by guest
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 27.20 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 04/21/09 15:29:47 by ABK FEES CHANGED ON CANCELLED ITEMS 164.80
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0,00
SURCHARGE APPLIED AGAINST CANCELLED FEES 137.60
NET AMOUNT 27.20
:TOTAL AMOUNTREFUNDED" 27.20.,
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 27.20 Made By REFUND FINAN With Reference James Baynes refund; for Apr 15 pymt
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 cas or credit card refunds. t
Autho ed Si at a Date Authorized Signature Date
U 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.
Baynes, James Terms
1629 Centaur Circle Date Due
Lafayette, CO 80026
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/21109 252086 Refund 27.20
Total 27.20
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6
,20_
Clerk- Treasurer
Voucher o. Warrant No.
Baynes, James Allowed 20
1629 Centaur Circle
Lafayette, CO 80026
III Sum of
27.20
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
l or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 252086 4358400 27.20 1 hereby certify that the attached invoice(s), or
ills) 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
Signature
27.20 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund