176766 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 363289 Page 1 of 1
ONE CIVIC SQUARE SUSANN HAASE CHECK AMOUNT: $45.00
CARMEL, INDIANA 46032 3016 WARREN WAY #D
CARMEL IN 46033 CHECK NUMBER: 176766
CHECK DATE: 9/2/2009
DEP ARTMENT ACCOUNT PO NU MBER INVOICE NUMBER AMOUNT DESCR IPTION
°1047 4358400 45.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 331235
Payment Date: 08/26/2009 V D
Household 18197
Home Phone: (317)571 -1433 AUG 2 8 2009
Work Phone:
zT.
SUSANN HAASE Monon Center
3016 WARREN WAY D Carmel IN 46032
CARMEL IN 46033
Phone: (317)848-7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 45.00
Enrollee Name: Emil Haase
Y Fees +Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 193007 -30 Starfish Level 2 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 07/07/2009 (Cancelled)
r Class Location: Indoor La Pool 2
P Class Dates: 08/11/2009 to 09/03/2009
Monon Center 6:15P to 6:45P
Carmel, IN 46032 Tu,Th
(317)848 -7275 Scheduled Sessions: 8
h Fee Details: Fee Description
Turtle Level 2 (Yout Amount Count Discount Sales Tax
7.00 1.00 Total Fee
0.00 0.00 7.00
cancel Reason: advanced request
G/L Code Descri
999999 Control Account (Ap) Account Number C Cntr
,r Enter Control Acct CNTRL Account Number
The REVENUE account was DEBITED and the CONTROL account was CREDITED on he day of th unt (AP) mount
Finance Enter Control Acct here will have to DEBIT the CONTROL account for the amounts listed above after 45.00 DR
y e refund.
the checks have been written to the customers.
Processed on 0 8/26/08 PREVIOUS NET H OUSEHOLD 10:23:03 by CEK BALANCE
FEES CHANGED ON CANCELLED ITEMS 0.00
DISCOUNT APPLIED AGAINST CANCELLED FEES
SALES TAX CHARGED ON C ANCELLED F 52.00
SURCHARGE APPLIED AGAINST C ANCELLED FE FE 0.00
ES 0.00
NET:A MQUNT.FRO M 7 .00
CANC ELLEDITE
TOTAL MS"
A'MOUNT,REF,U 45:00=
NDEt)'
Refund of
NEW NET HOUSEHOLD BALANCE 45:00
45.00 Made By REFUND FINAN With Referenc ce advanced re 0.00
quest
T
I'
f
�i
�7y
ACTIVITY REFUND RECEIPT
Receipt 331235
Payment Date: 08/26/2009
Household 18197
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 r c r edit card refunds.
Authorized Signature Date Authorized Signature Date
I
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.
Haase, Susann Terms
3016 Warren Way D Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/26/09 331235 Refund 45.00
Total 45.00
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.
Haase, Susann Allowed 20
3016 Warren Way D
Carmel, IN 46033
In Sum of
45.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 331235 4358400 45.00 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
28 -Aug 2009
Signature
45.00 Accounts Payable Coordinator.
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund