169005 02/17/2009 CITY OF CARMEL, INDIANA VENDOR: T362564 Page 1 of 1
ONE CIVIC SQUARE HILLARY HUSHOWER
fo CARMEL, INDIANA 46032 531 N RANGELINE RD CHECK AMOUNT: $10.00
CARMEL IN 46032
CHECK NUMBER: 169005
CHECK DATE: 211712009
DE PARTMENT A PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 225285 10.00 REFUNDS AWARDS INDE
w
s ACTIVITY REFUND RECEIPT
Receipt 225285 -ATV a
Payment Date: 02/05/2009
Household 24055 FEB 1 1 2009
Home Phone: (317)575 -1115
Work Phone:
BY:
HILLARY HUSHOWER Monon Center
531 N RANGELINE RD. Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 10.00
Enrollee Name: Hillary Hushower Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 397800 -01 Senior Health Fair 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 01/07/2009 (Cancelled)
Class Location: Program Rms A, B, C Class Dates: 02/21/2009 to 02/21/2009
Monon Center 8:OOA to 12:OOP
Sa
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 1
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 10.00 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 02/05/09 12:31:21 by MML FEES CHANGED ON CANCELLED ITEMS 10.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED'ITEMS .10.00-
TOTAL AMOUNT REFUNDED 10.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 10.00 Made By REFUND F4NAN With Reference low enrollment
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.
Page 1
ACTIVITY REFUND RECEIPT
Receipt 225285
Payment Date: 02/05/2009
Household 24055
OWY
Authori ignature Date Authorized Signature Date
hil-
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.
Hushower, Hillary Terms
531 N Rangeline Rd Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/5/09 225285 Refund 10.00
Total 10.00
I 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.
Hushower, Hillary Allowed 20
531 N Rangeline Rd
Carmel, IN 46032
In Sum of
Q
10.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 225285 4358400 10.00 t 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 -Feb 2009
--a
Signature
10.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund