172763 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 362900 Page 1 of 1
ONE CIVIC SQUARE KRISTIN BUSHA
CARMEL, INDIANA 46032 14350 AVIAN WAY
CHECK AMOUNT: $85.00
CARMEL IN 46033 CHECK NUMBER: 172763
CHECK DATE: 5/27/2009
j� DEPA RTMENT ACCOU PO NU MBE R INVOIC NUMBER AMOUNT DESCRIPTI
1047 4358400 257896 85.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 257896 T
Payment Date: 0511312009?
`tousehold 25983
Kome Phone: (317)564 -4274
Work Phone: (317) MAY 2 1 2009 _J
LL_7;
KRISTIN BUSHA Monon Center
14350 AVIAN WAY Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 85.00
Enrollee Name: Ethan Busha Fees Tax Discount Prey Paid Cur Paid Amount Due
Activity Number: 195014 -01 Pee Wee Golf 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 04116/2009 (Cancelled)
Primary Instructor. Plum Creek Golf
Class Location: Plum Creek Golf Club Class Dates: 05/19/2009 to 05/22/2009
Plum Creek Golf Cour 8:30A to 9:30A
12401 Lynnwood Blvd. Tu,W,Th,F
Carmel, IN 46033 Scheduled Sessions: 4
(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 85.00 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 05/13/09 08:28:36 by CNA FEES CHANGED ON CANCELLED ITEMS 85.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES O.00
MET: AMOUNT. FROM: CANCELLED ITEMS: 85.00
TOTAL AMOUNT REFUNDED
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 85.00 Made By REFUND FINAN With Reference low enrollment
Page 1
ACTIVITY REFUNDS RECEIPT
Receipt 257896
Payment Date: 05/13/2009
Household 25983
All refunds are subject to State Board of Accounts claim procedure and may take 46 weeks to process. A check will be
issued. No cash or credit card refunds.
5 Q o�
Aut4rized Signature Date Authorized Signature Date
3 30. �357
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.
Busha, Kristin Terms
14350 Avian Way Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5113/09 257896 Refund 85.00
Total 85.00
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.
Busha, Kristin Allowed 20
14350 Avian Way
Carmel, IN 46033
In Sum of$
a, 85.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #1TITLE AMOUNT Board Members
Dept
1047 257896 4358400 85.00 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
21 -May 2009
Signature
85.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund