176131 08/19/2009 a CITY OF CARMEL, INDIANA VENDOR: 363236 Page 1 of 1
ONE CIVIC SQUARE LAURA BALTZ
0
CARMEL, INDIANA 46032 666 BENNETT ROAD CHECK AMOUNT: $64.00
CARMEL IN 46032 CHECK NUMBER: 176131
CHECK DATE: 8/19/2009
DEPARTMENT A CCOUNT PO NUMBER INV OICE NUMBE AMO UNT DE SCRIPTI ON
1047 4358400 316378 64.00 REFUNDS AWARDS INDE
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ACTIVITY REFUND RECEIPT
Receipt 316378
Payment Date: 08/04/2009 AUG 0 2009
Household 562
Home Phone: (317)587 -8838
Work Phone: (317)
-r
LAURA BALTZ Monon Center
866 BENNETT RD. Carmel IN 46032
CARMEL IN 46032
Phone: (317)848-7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 38.00
Enrollee Name: Jasper Baltz Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 193008 -11 Seahorse Level 3 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 04/05/2009 (Cancelled)
Class Location: Indoor Lap Pool 3 Class Dates: 06/29/2009 to 07/22/2009
Monon Center 5:30P to 6:OOP
M,W
Carmel, IN 46032 Scheduled Sessions: 8
(317)848 -7275
Fee Details: Fee Des Amount Count Discount Sales Tax Total Fee
Porpoise Level 3 (Yo 7.00 1.00 0.00 0.00 7.00
Cancel Reason: Pro -Rated Request
CANCELLATION Refund Of 26.00
Enrollee Name: Jasper Baltz Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 193009 -22 Stingray L4 (Youth) 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 04/05/2009 (Cancelled)
Class Location: Idr Lap Pool Class Dates: 07/27/2009 to 07/30/2009
Monon Center 5:45P to 6:15P
M,Tu,W,Th
Carmel, IN 46032 Scheduled Sessions: 4
(317)848 -7275
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Whale Level 4 (Youth 7.00 1.00 0.00 0.00 7.00
Cancel Reason: Pro -Rated Request
Page 1
v ACTIVITY REFUND RECEIPT
Receipt 316378
Payment Date: 08/04/2009
Household 562
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 64.00 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 08/04/09 11:47:44 by ALC FEES CHANGED ON CANCELLED ITEMS 78.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 14.00
NET AMOUNT FROM CANCELLED ITEMS 64.00
TOTAL AMOUNT REFUNDED 64.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 64.00 Made By REFUND FINAN With Reference
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.
'k?,/73 aa
Authorized Signature Date Authorized Signature Date
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.
Baltz, laura Terms
866 Bennett Rd Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/4/09 316378 Refund 64.00
Total 64.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Baltz, Laura LAUrzA Allowed 20
866 Bennett Rd
Carmel, IN 46032
In Sum of$
64.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 316378 4358400 64.00 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
13 -Aug 2009
Signature
64.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund