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Home My WebLink About168507 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: T362472 Page 1 of 1 ONE CIVIC SQUARE LAURIE HELMS CHECK AMOUNT: $160.00 s`. CARMEL, INDIANA 46032 115 ROLLING RIDGE ROAD SHELBYVILLE IN 46176 CHECK NUMBER: 168507 CHECK DATE: 2/4/2009 DEP ARTMENT AC COUNT PO N UMB E R IN VOICE NUMBER AM OUNT D 1047 4358400 160.00 PARKS DEPARTMENT REFU .r r,. PASS REFUND RECEIPT Receipt 223473 f Ck Payment Date: 01/30/2009 Ul Household 8671 I Home Phone: (317)688 -2164 �-R v�S Work Phone: )(,r ►'1 �l��i� �,)e MEDICAL CENTER CLARIAN NORTH Carmel Clay Parks Recreation 11700 N. MERIDIAN 1235 Central Park Drive East CARMEL IN 46032 Carmel IN 46032 Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Pass Details MEMBERSHIP CHANGE Refund Of 160.00 Pass Holder: Laurie Helms Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Prm Yr Adult R (PRMYRADR), #11030 0.00 0.00 0.00 0.00 0.00 Valid Dates: 07/15/2008 to 07/15/2009 Pass Change) Auto -Debit Details: 16 Current/Previous Bill(s) Totaling $459.20 Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee Prem. Yearly Adult R 0.00 1.00 0.00 0.00 0.00 G/ Cod Descriptio Account Number Cst Cntr Description Account Number A mount 999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 160.00 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 01/30/09 10:21:32 by ABK FEES ADJUSTED ON CHANGED ITEMS Purchase 160.00 /C n� DISCOUNT APPLIED AGAINST THESE FEES 0.00 Description SALES TAX CHARGED ON CHANGED FEES 0.00 P.O. PGri G.L. 42 NET AMOUNT FROM CHANGED ITEMS` 160:00 B TOTAL" AMOUNT REFUNDED 160.00 Page 1 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. Helms, Laurie Terms 115 Rolling Ridge Rd Date Due Shelbyville, IN 46176 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 1/30/09 223473 Refund 160.00 Total 160.00 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. Helms, Laurie Allowed 20 115 Rolling Ridge Rd Shelbyville, IN 46176 In Sum of r 160.00 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members Dept 1047 223473 4358400 160.00 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 2 -Feb 2009 Signature 160.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund PASS REFUND RECEIPT Receipt 223473 /`e d Vk_ 4 Payment Date: 01/30/2009 li Household 8671 Home Phone: (317)688 -2164 vy,--s Work Phone: Ske_ VA)e l 4 (0)7 MEDICAL CENTER CLARIAN NORTH Carmel Clay Parks Recreation 11700 N. MERIDIAN 1235 Central Park Drive East CARMEL IN 46032 Carmel IN 46032 Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Pass Details MEMBERSHIP CHANGE Refund Of 160.00 Pass Holder: Laurie Helms Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Prm Yr Adult R (PRMYRADR), #11030 0.00 0.00 0.00 0.00 0.00 Valid Dates: 07/15/2008 to 07/15/2009 Pass Change) Auto -Debit Details: 16 Current/Previous Bill(s) Totaling $459.20 Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee Prem. Yearly Adult R 0.00 1.00 0.00 0.00 0.00 G/ 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 160.00 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 01/30/09 10:21:32 by ABK FEES ADJUSTED ON CHANGED ITEMS 160.00 De ch399 n c f 1 J DISCOUNT APPLIED AGAINST THESE FEES Descriptlofl V 0.00 P.O. Pr P SALES TAX CHARGED ON CHANGED FEES 0.00 G.L. 9 N 3 5 NET AMOUNT FROM CHANGED ITEMS 160.00- Bud Line TOTAL "AMOUNT +REFUNDED" 16000 V Purchases NEW NET HOUSEHOLD BALANCE 0.00 Refund of 160.00 Made By REFUND FINAN With Reference Pass canceled 8/08 All refunds are subject to St a Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be issued. No cash or credit rd Lefunds Authoriz d Signature Date Authorized Signature Date Page 1