167781 01/20/2009 CITY OF CARMEL, INDIANA VENDOR: T362359 Page 1 of 1
ONE CIVIC SQUARE KIM HUGHES CHECK AMOUNT: $40.00
4. CARMEL, INDIANA 46032 12943 TUSCANY BLVD
CARMEL IN 46032 CHECK NUMBER: 167781
CHECK DATE: 1/20/2009
DEPARTME ACCOU PO NUM BER I NVOICE NUM BER AMOUNT DESCRIPTION
1047 4358400 215242 40.00 REFUNDS AWARDS INDE
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PASS REFUND RECEIPT
Receipt 215242
Payment Date: 01/05/2009��
Household 12649 JAN 0 5 2009
Home Phone: (317)733 -0478
Work Phone: (317)
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KIM HUGHES Carmel Clay Parks Recreation
12943 TUSCANY BLVD 1235 Central Park Drive East
CARMEL IN 46032 Carmel IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 40.00
Pass Holder: Kim Hughes Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #15519 0.00 0.00 0.00 0.00 0.00
Valid Dates: 10/03/2008 to 10/22/2009 Pass Cancellation)
Cancel Reason: Informed pas ran out after a year, wanted pass to be done after 1 yr. Was auto renewed and
charged on 12/15 for unwanted pass
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 40.00 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 01/05/09 14:24:28 by TMW FEES CHANGED ON CANCELLED ITEMS 40.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT 'F,ROMTCANCELLED4TEMS
-T.OTAL'.ANiGUNT•REFUNDED; 40:00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 40.00 Made By REFUND FINAN With Reference ==(C�kRefund
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.
Authorized Signature Date Authorized Signature Date
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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.
Hughes, Kim Terms
12943 Tuscany Blvd Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/5/09 215242 Refund 40.00
Total 40.00
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.
Hughes, Kim Allowed 20
12943 Tuscany Blvd
Carmel, IN 46032
I n Sum of
40.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 215242 4358400 40.00 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
15 -Jan 2009
Signature
40.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund