173243 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 362924 Page 1 of 1
ONE CIVIC SQUARE LOIS BUCHBACHER
CHECK AMOUNT: $154.00
CARMEL, INDIANA 46032 5891 TALL TIMBER RUN
y o CARMEL IN 46033 CHECK NUMBER: 173243
CHECK DATE: 6/10/2009
4DEPARTMENT ACCOUNT PO NUMBER INVO NUMBER A MOUNT DES
1046 4358400 154.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Rerkeipt 267054
Payment Date: 06/01/2009
Household 4382
Home Phone: (317)574 -9920 12, �7 s -a
Work Phone: (317)554 -0000 7! 6
P�z JUN 0 2 2009
LOIS BUSCHBACHER Monon Center,
5891 TALL TIMBER RUN Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 154.00
Pass Holder. Walter Buschbacher Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: 20 Visit (ESE20V), #35919 66.00 0.00 66.00 0.00 0.00
Valid Dates: 08112/2008 to 05/29/2009 Pass Cancellation)
Pass Visit Info: Number of Visits: 14
Fee Details: Fee Description Amount Count Discount S ales Tax Total Fee
20 Visit Punchcard 66.00 1.00 0.00 0.00 66.00
Cancel Reason: only used 6 of the 20 visits
G1L 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 154.00 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 06101/09 12:52:09 by JAS FEES CHANGED ON CANCELLED ITEMS 154.00
DISCOUNT APPLIED AGAINST CANCELLED FEES O 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NETAMOUNTrEROM 'CANCELLED'ITEMS °_154.00-
TOTAL AMOUNTIREFUNDED "154.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 154.00 Made By REFUND FINAN With Reference chk refund
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issue No c
t or credit card refunds.
Authorized Signature Date Authorized Signature Date
Page 1
P. REFUND RECEIPT
Receipt 0 ?5705.1
Payment 0 0
Home l"h.- i I 1-":920 V.,
Work P11( ;I -0000
J UN 0 2 2009
D'Y.
C 1 1Z Monon Ccntor
Tlf,.IEER [RUN Carmel IN 46032
Mi-- IH JJ
Phone: (317)848-7275
Fed Tax 11) 1,
Pass D,..t-
.^4.,'.!CFI-LATION Rehind Of 154.00
Pass I i"tischlbacher Fees+ Tax Prev!'ziid Cur Paid Amount Due
177 -1 55.00 0.00
Pass l, -SE20V), h3� 19 66.09 G
1
0.00
05/20/200')
Pass Cancellation)
Pass vi.i.: C V i s i t s 'I
Fee D,: Os: FrT Description Amount Count [';s,C:nuri: S;flc Ta x Total Fee
7D Visit Purichcard (35,00 1.00 0.00 0.00 66.00
C 6 of the 20 vi,,::;
&.cc ;ju;iitcr Cst Cntr Description Account Number Amount
90
Enter Control Acct CNTRL Control Account (Ail) Enter Control Acct here 154.00 DR
Thr, R: was CREDITED on the day of the
r.oucts listed above after the checks have j) lo 0,c ci, '.:;,crs.
PREVIOUS NET IIOUS;zi:,LD BALANCE 0.00
FEES CHANGED 0:: CA;,'- I I ELi 154.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS
154.00
TOTAL AMOUNT PFFuNnED 154.00
NEW NET HOUSEHOI ',t-ANCE 0.00
chk refund
All re; to Stitc Board of Accounts .,tiinn procedure and may U�':: 1 4: to Picccss. A check will be
'nds.
Authorized
Date
uvi)i V0 Page 1
WD
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.
Buschbacher, Lois Terms
5891 Tall Timber Run Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/1/09 267054 Refund 154.00
I
Total 154.00
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.
Buschbacher, Lois Allowed 20
5891 Tall Timber Run
Carmel, IN 46033
In Sum of
154.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 267054 4358400 154.00 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
4 -Jun 2009
Signature
154.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund