168507 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
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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
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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
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