176152 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: T0003029 Page 1 of 1
ONE CIVIC SQUARE KIMBERLY BREMER
CARMEL, INDIANA 46032 5308 BREAKERS WAY CHECK AMOUNT: $175.00
s CARMEL IN 46033 CHECK NUMBER: 176152
CHECK DATE: 8/1912009
DEPAR ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRI
1046 4358400 317059 175.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 317059
Payment Date: 08/05/2009
Household 533 A U G 0 6 2009
Home Phone: (317)571 -0405
Work Phone:
KIMBERLY BREMER Monon Center
5308 BREAKERS WAY Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Orio Bal Refund New Bal
Module: Activity Registration 175.00- 175.00 0.00
GIL 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 175.00 DR
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 175.00
Processed on 08/05/09 @a 14:39:53 by JAS NEW REFUND AMOUNT 175.00
TOTAL REFUNDABLE AMOUNT 175.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 175.00 Made By REFUND FINAN With Reference check refund
All r funds re subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issu d. N c sh or credit card refunds.
V, A
Au rf d Si a ure Date Authorized Signature Date
owvv 0" tril
6 V
v P��
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.
Bremer, Kimberly Terms
5308 Breakers Way Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8!5109 317059 Refund 175.00
Total 175.00
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.
Bremer, Kimberly Allowed 20
5308 Breakers Way
Carmel, IN 46033
In Sum of
175.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#ITITLE AMOUNT Board Members
Dept
1046 317059 4358400 175.00 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
ow Ly
Signature
175.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund