178238 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 363405 Page 1 of 1
4� ONE CIVIC SQUARE KELLEY KARPINSKI CHECK AMOUNT: $40.00
CARMEL, INDIANA 46032 4616 ROYAL OAKS LANE
CARMEL IN 46032 CHECK NUMBER: 178238
CHECK DATE: 10/14/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 341757 40.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
3
Receipt 341757
Payment Date: 10/02/2009 0 C T 0 2009
Household 14573
Home Phone: (317)848 -6920
KELLEY KARPINSKI Monon Center
4616 ROYAL OAKS LN. Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 40.00
Enrollee Name: Kelley Karpinski Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 299002 -01 Family Campout 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 09/22/2009 (Cancelled)
Class Location: West Park Shelter Class Dates: 09/25/2009 to 09/26/2009
West Park 4:30P to 9:OOA
2700 W. 116th St. F,Sa
Carmel, IN 46032 Scheduled Sessions: 2
(317)848 -7275
Cancel Reason: advanced request
G/L 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 40.00 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 10/02/09 13:59:19 by SAC FEES CHANGED ON CANCELLED ITEMS 40.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED.ITEMS 40.00-
TOTAL AMOUNT REFUNDED. 40.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 40.00 Made By REFUND FINAN With Reference advanced request
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.
Page 1
f
ACTIVITY REFUND RECEIPT
Receipt 341757
Payment Date: 10/02/2009
Household 14573
Authorized ignature 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.
Karpinski, Kelley Terms
4616 Royal Oaks Ln Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/2/09 341757 Refund 40.00
Total 40.00
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.
Karpinski, Kelley Allowed 20
4616 Royal Oaks Ln
Carmel, IN 46032
d In Sum of
40.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 341757 4358400 40.00 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
7 -Oct 2009
Signature
40.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund