170932 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 362762 Page 1 of 1
ONE CIVIC SQUARE PANDIMADEVI JAYASEELAPANDIYAN
t CHECK AMOUNT: $229.17
�,?o CARMEL, INDIANA 46032 1430 FAIRFAX MANOR APT 20
CARMEL IN 46032 CHECK NUMBER: 170932
CHECK DATE: 4116/2009
DEPARTMENT ACCOU PO NU INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 229".17 REFUNDS AWARDS INDE.
f PASS REFUND RECEIPT
Receip 24
Pa D
Pa ment Date: 04106/2 009
Household 22656
Home Phone: (317)704 -8944
Work Phone: A P R 0 7 lo
BY:
PANDIMADEVI JAYASEELAPANDIYAN Monon Center
1430 FAIRFAX MANOR Carmel IN 46032
APT 2D
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 229.17
Pass Holder: Pandimadevi Jayaseelapandiyan Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly GF Res Unli (YGFRU), #40960 20.83 0.00 0.00 20.83 0.00
Valid Dates: 10101!2008 to 10/01/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yearly GF Res Unlimi 20.83 1.00 0.00 0.00 20.83
Cancel Reason: not use pass /staff error in cancellation procedure /cancellation was not processed in
November
GIL Code Descri Acco Number Cst Cntr Description Accou N umber Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 229.17 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 04/06/09 14:14:35 by SLR FEES CHANGED ON CANCELLED ITEMS 250.00-
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 20.83
?NETAMOUNT,FROM CANCELLED ITEMS ,229:17l'
TOTAL,- AMOUNT REFUNDED„ ,g >�229A7.r
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 229.17 Made By REFUND FINAN With Reference check refund
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.
r f Page 4 1
Z10 q3 5F�oo
PASS REFUND RECEIPT
Receipt 245584
Payment Date: 04/06/2009
Household 22656
Authorized Signature Date Authorized Signature Date
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.
Jayaseelapandiyan, Pandimadevi Terms
1430 Fairfax Manor, Apt 2D Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
416109 245584 Refund 229.17
Total 229.17
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,
Jayaseelapandiyan, Pandimadevi Allowed 20
1430 Fairfax Manor, Apt 2D
Carmel, IN 46032
In Sum of
229.17
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #rfITL AMOUNT Board Members
Dept
1047 245584 4358400 229.17 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
10 -Apr 2009
Signature
229.17 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund