175729 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 363195 Page 1 of 1
ONE CIVIC SQUARE JACQUELINE HOLCOMB CHECK AMOUNT: $8.00
CARMEL, INDIANA 46032 PO BOX 9
WESTFIELD IN 46074 CHECK NUMBER: 175729
CHECK DATE: 8/6/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NU MBER A MOUNT DESCRIPTION
1047 4358400 305016 8.00 REFUNDS AWARDS INDE
n
ewe
ACTIVITY REFUND RECEIPT
Receipt 305016
Payment Date: 07/17/2009
Household 27601 J U I
Home Phone: (317)571 -9230
Work Phone:
R?F�:
JACGUELINE HOLCOMB Monon Center
P.O. BOX 9 Carmel IN 46032
WESTFIELD IN 46074
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 8.00
Enrollee Name: Thomas Holcomb Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 196444 -02 Video Game Tournamen 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 06/08/2009 (Cancelled)
Primary Instructor: CCPR Staff
Class Location: Program Room B Class Dates: 07/25/2009 to 07/25/2009
Monon Center 3:OOP to 5:OOP
Sa
Carmel IN 46032 Scheduled Sessions: 1
(317)848 -7275
Cancel Reason: IOW 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 8.00 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 07/17/09 14:08:47 by LVA FEES CHANGED ON CANCELLED ITEMS 8.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS.
TOTAL AMOUNT REFUNDED 8.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 8.00 Made By REFUND FINAN With Reference low enrollment
Page 1
ACTIVITY REFUND RECEIPT
Receipt 305016
Payment Date: 07/17/2009
Household 27601
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 cash or credit card refunds.
9L" N 0q 3 �`1
Authorized ature ate Authorized Signature Date
1 1 7 qcU. g2O.1 -1 g7o�
l Ca mi- u r �o c�J Cnro 1wu� V 6 deo
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.
Holcomb, Jacqueline Terms
P.O. Box 9 Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/17/09 305016 Refund 8.00
Total 8.00
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.
Holcomb, Jacqueline Allowed 20
P.O. Box 9
Westfield, IN 46074
In Sum of
8.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 305016 4358400 8.00 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
30 -Jul 2009
A&HO"ne
Signature
8.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund