176824 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 355252 Page 1 of 1
ONE CIVIC SQUARE SHALINI KOHLI
CARMEL, INDIANA 46032 326 ARBOR DRIVE CHECK AMOUNT: $175.20
CARMEL IN 46032 CHECK NUMBER: 176824
CHECK DATE: 9/2/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4358400 175.20 PARKS DEPARTMENT REFU
PASS REFUND RECEIPT
Receipt 331501
Payment Date: 08/27/2009
Household 5520 AUG 2 8 2009
Home Phone: (317)225 -2531
Work Phone:
SHALINI KOHLI Monon Center
326 ARBOR DR. Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Orio Bal Refund New Bal
Module: Pass Management 175.20- 175.20 0.00
G/L Code Description Account Number C_s_t_Cntr Description___________ Account Number__,___ Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 175.20 DR
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 175.20
Processed on 08/27/09 13:42:41 by JAS NEW REFUND AMOUNT 175.20
TOTAL REFUNDABLE AMOUNT 175.20
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 175.20 Made By REFUND FINAN With Reference check refund
All T.efunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
iss ed 'No cash or credit card refunds.
x ,11 0 0
ut r ed Si re Date Authorized Signature Date
2A
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.
Kohli, Shalini Terms
326 Arbor Dr Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/27/09 331501 Refund 175.20
Total 175.20
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.
Kohli, Shalini Allowed 20
326 Arbor Dr
Carmel, IN 46032
In Sum of
175.20
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #(TITLE AMOUNT Board Members
Dept ept
1046 331501 4358400 175.20 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
175.20 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund